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Contact Information

MATTHEW D MCKISSOCK, DMD
4769 THE GROVE DR.
SUITE 100
WINDERMERE, FL34786
 Phone: 407-909-1099
 Fax: 407-909-1599
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for MATTHEW D MCKISSOCK · (Male)

NPI # 1104049543
Status Active
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 04/11/2007
Last updated 09/22/2022 - About 4 years ago
Sole proprietor 1 Yes
Identifiers
  • FL License # DN14895
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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