Benjamin Andrew McKinley, D.D.S.
Individual provider Active NPI General Practice Dentistry · Webster, WI
NPI 1497067722 · NPPES record last updated Dec 13, 2023
Key facts
- NPI
- 1497067722
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1002054 (WI)
- Practice address
- 26425 Lakeland Ave S
Webster, WI 54893-8343 - Phone
- (715) 866-4420
- Fax
- (715) 866-4368
- NPI assigned
- Jul 1, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160406002036 | MN | Order and Referring Only - Oral Surgery |
1052619137 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1002054 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benjamin McKinley DDS, LLC. | Dentist | Current | Accepting new patients |
Locations
26425 Lakeland Ave S
Webster, WI 54893
Phone (715) 866-4271
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D12788 | MN | |
| General Practice Dentistry | 1223G0001X | 1002054 | WI | Yes |
Addresses
Primary practice location
26425 Lakeland Ave S
Webster, WI 54893-8343
Mailing address
235 E State St
Saint Croix Falls, WI 54024-4117
Phone (715) 483-3221
Other providers in Webster, WI
- Theresa Lubich
- Dona Lundmark
- Aliya Mansoor
- Patti Mataxen
- Brianne Elizabeth Matrious
- Tania M McKnight
- Jennifer L McNamara
- Susan Evelyn Merchant
- Holly Mishler-Johnson
- Mackenzie Emma Mitchell
All providers in Webster, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.