MEDICARE: DR. DANIEL CLAYTON MCKINNEY D.D.S.

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	1223G0001X	General Practice Dentistry	WI4908	WI

General Provider Information

NPI Number	:	1780689216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL CLAYTON MCKINNEY D.D.S.

Provider Business Mailing Address
First Line	:	1410 NORTHPORT DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-2041
Country	:	US
Telephone Number	:	608-249-6511
Fax Number	:	608-249-0778

Provider Business Practice Location Address
First Line	:	1410 NORTHPORT DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-2041
Country	:	US
Telephone Number	:	608-249-6511
Fax Number	:	608-249-0778

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	12/17/2009

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