Provider Demographics
NPI:1578814844
Name:RAY N MCKINLEY DDS PC
Entity type:Organization
Organization Name:RAY N MCKINLEY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-685-0880
Mailing Address - Street 1:45665 VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6068
Mailing Address - Country:US
Mailing Address - Phone:586-685-0880
Mailing Address - Fax:586-685-0885
Practice Address - Street 1:45665 VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-6068
Practice Address - Country:US
Practice Address - Phone:586-685-0880
Practice Address - Fax:586-685-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID10907261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MITYPE 1 NPIOther1730211939