Provider Demographics
NPI:1073770384
Name:MCCORMACK, DAVID ALAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:MCCORMACK
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: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:GLEN MORGAN
Practice Address - State:WV
Practice Address - Zip Code:25813-7709
Practice Address - Country:US
Practice Address - Phone:304-255-2898
Practice Address - Fax:304-255-9487
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV32211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice