Provider Demographics
NPI:1669518296
Name:MCKINNEY, KRIS DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:KRIS
Middle Name:DALE
Last Name:MCKINNEY
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 1:5121 S SOLBERG AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2220
Mailing Address - Country:US
Mailing Address - Phone:605-339-2955
Mailing Address - Fax:605-373-0235
Practice Address - Street 1:5121 S SOLBERG AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2220
Practice Address - Country:US
Practice Address - Phone:605-339-2955
Practice Address - Fax:605-373-0235
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice