Provider Demographics
NPI:1033292990
Name:MCCORMICK, ROY KIRK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:KIRK
Last Name:MCCORMICK
Suffix:
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 1:4528 LAGO VIENTO
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-1909
Mailing Address - Country:US
Mailing Address - Phone:512-667-0515
Mailing Address - Fax:
Practice Address - Street 1:604 CRYSTAL FALLS PKWY
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1902
Practice Address - Country:US
Practice Address - Phone:512-260-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice