MEDICARE: MACKENZIE MARIE KLEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	030297	NY

General Provider Information

NPI Number	:	1659198935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE MARIE KLEE

Provider Business Mailing Address
First Line	:	1890 COUNTY ROAD 6
Second Line	:
City	:	PHELPS
State	:	NY
Zip	:	14532-9533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4075 W LAKE RD
Second Line	:
City	:	GENEVA
State	:	NY
Zip	:	14456-9756
Country	:	US
Telephone Number	:	315-789-5040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	09/26/2024

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