Johnny L. McKinnon Jr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6063 Issued in NC

Practice address

407 N Main St
Mount Gilead, NC 27306-0407

Phone

(910) 439-9744

Fax

(910) 439-4113

NPI assigned

Sep 26, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Johnny L. McKinnon, Jr., D.D.S., P.a.

  • General Practice Dentistry
  • Mount Gilead, NC
  • NPI 1376712075
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1124129341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22",
            "city": "MOUNT GILEAD",
            "state": "NC",
            "postal_code": "273060022",
            "telephone_number": "910-439-9744",
            "fax_number": "910-439-4113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 N MAIN ST",
            "city": "MOUNT GILEAD",
            "state": "NC",
            "postal_code": "273060407",
            "telephone_number": "910-439-9744",
            "fax_number": "910-439-4113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNON",
        "first_name": "JOHNNY",
        "middle_name": "L.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "6063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8995803",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Johnny L. McKinnon, Jr., D.D.S., P.a.
• Agnes K Kirkpatrick
• Allison K Little, PA
• Ursula Nichole Little, RN
• Lolasafehaventt@Gmail.Com
• MCPC-8, LLC (FirstHealth Convenient Care - Lake Tillery)
• Bobby McRae
• Moderate Living for the Aging Inc (Mt. Gilead Independent Senior and Assisted Living)
• Monarch
• Monarch

• General Practice Dentistry in Mount Gilead, NC
• Providers in Mount Gilead, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.