Provider Demographics
NPI:1033212493
Name:DAVID MCCORMACK DDS
Entity Type:Organization
Organization Name:DAVID MCCORMACK DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DDS
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-255-2898
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813
Mailing Address - Country:US
Mailing Address - Phone:304-255-2898
Mailing Address - Fax:304-255-9487
Practice Address - Street 1:701 RITTER DR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813
Practice Address - Country:US
Practice Address - Phone:304-255-2898
Practice Address - Fax:304-255-9487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty