Mckissock Corp
NPI #1831459551 in Windermere, Florida
Provider Information
- NPI Number
- 1831459551
- Entity Type
- Organization
- Organization Name
- Mckissock Corp
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- MCKISSOCK CORP
- Primary Specialty
- Dentist
- Enumeration Date
- May 29, 2012
- Last Updated
- May 29, 2012
Practice Location
- Address
- 4769 THE GROVE DR.
- Address 2
- SUITE 100
- City
- Windermere
- State
- Florida
- ZIP Code
- 34786
- Phone
- (407) 909-1099
Authorized Official
- Name
- DR. MATTHEW DEAN MCKISSOCK, D.M.D.
- Title
- OWNER/PRESIDENT
- Phone
- (407) 909-1099
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
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