Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D009935 | AZ |
NPI | 1003336215 |
---|---|
Provider Name | Dr. James Nathan Mckenna |
First Address | Seattle, WA 98102-4086 |
Second Address | Phoenix, AZ 85007-3101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2017 |
Last Update Date | 09/04/2018 |