Provider Demographics
NPI:1447322144
Name:MACKENZIE, KENE (DDS)
Entity type:Individual
Prefix:DR
First Name:KENE
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3164 SE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66607-2204
Mailing Address - Country:US
Mailing Address - Phone:785-233-0956
Mailing Address - Fax:785-233-5116
Practice Address - Street 1:3164 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66607-2204
Practice Address - Country:US
Practice Address - Phone:785-233-0956
Practice Address - Fax:785-233-5116
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS60202OtherKANSAS DENTAL LICENSE
KS200271250AMedicaid
BM8466674OtherDEA