Provider Demographics
NPI:1700898715
Name:MACKIE, WILLIAM ROLAND II (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROLAND
Last Name:MACKIE
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 MAIN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1976
Mailing Address - Country:US
Mailing Address - Phone:303-466-2221
Mailing Address - Fax:303-466-7735
Practice Address - Street 1:925 MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1976
Practice Address - Country:US
Practice Address - Phone:303-466-2221
Practice Address - Fax:303-466-7735
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO100968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist