Philip Evan McKenzie, DDS, MS, FRCDC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

D13597 Issued in MN

Practice address

3360 Northdale Blvd NW
Coon Rapids, MN 55448-1601

Phone

(763) 233-3322

NPI assigned

Jul 23, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1406073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1619385556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 COUNTY ROAD C W STE 2210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132551",
            "telephone_number": "763-233-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3360 NORTHDALE BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554481601",
            "telephone_number": "763-233-3322"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12904 Central Ave NE",
            "address_purpose": "LOCATION",
            "city": "Blaine",
            "state": "MN",
            "postal_code": "554344147",
            "country_code": "US",
            "telephone_number": "763-233-3322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "PHILIP",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "DDS, MS, FRCDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-23",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MN",
            "license": "D13597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie McGrath
• Sloane Asha McGraw, D.O.
• Jamie Leigh McGuire, DNP
• Kevin McGuire, D.O.
• Kathleen M McKay
• Molly C McMahon, DPT
• Stephanie Elizabeth McMahon, BCBA
• Kelly Jo McMartin, LPCC
• Alea McPherson
• Deirdre Nicole McPherson, RDN, LDN, CDCES

• Endodontics in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Endodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.