NPIMap

Organization Active NPI

McKissock Corp.

  • Dentist
  • Windermere, FL
National Provider Identifier
1477938140
Registry record updated Aug 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN14895 Issued in FL
Legal business name
MCKISSOCK CORP.
Practice address
4769 The Grove Dr
Suite 100
Windermere, FL 34786-8421
Phone
(407) 909-1099
NPI assigned
Jul 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2015

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

Authorized official

Name
Dr. Matthew Dean McKissock, D.M.D.NPI 1104049543
Title
Owner/President
Phone
(407) 909-1099

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN14895 FL Primary

Addresses

Primary practice location

4769 The Grove Dr
Suite 100
Windermere, FL 34786-8421

Mailing address

4769 The Grove Dr
Suite 100
Windermere, FL 34786-8421
Phone (407) 909-1099

Other names 1

  • Windermere Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
McKissock Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1437609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439251200000",
    "number": "1477938140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4769 THE GROVE DR",
            "address_2": "SUITE 100",
            "city": "WINDERMERE",
            "state": "FL",
            "postal_code": "347868421",
            "telephone_number": "407-909-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4769 THE GROVE DR",
            "address_2": "SUITE 100",
            "city": "WINDERMERE",
            "state": "FL",
            "postal_code": "347868421",
            "telephone_number": "407-909-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKISSOCK CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-23",
        "last_updated": "2015-08-11",
        "status": "A",
        "authorized_official_last_name": "MCKISSOCK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "407-909-1099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN14895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Windermere Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Windermere, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2015; 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.