Provider Demographics
NPI:1225860083
Name:MCKOY DENTAL CENTER
Entity type:Organization
Organization Name:MCKOY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKOY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-252-1119
Mailing Address - Street 1:1313 E BROAD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-3510
Mailing Address - Country:US
Mailing Address - Phone:614-252-1119
Mailing Address - Fax:614-252-1265
Practice Address - Street 1:1313 E BROAD ST STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-3510
Practice Address - Country:US
Practice Address - Phone:614-252-1119
Practice Address - Fax:614-252-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty