Provider Demographics
NPI:1083624613
Name:DAVID MCCOY DDS PC
Entity Type:Organization
Organization Name:DAVID MCCOY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-479-2854
Mailing Address - Street 1:165 MOUSE CREEK RD NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3818
Mailing Address - Country:US
Mailing Address - Phone:423-479-2854
Mailing Address - Fax:423-479-5393
Practice Address - Street 1:165 MOUSE CREEK RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3818
Practice Address - Country:US
Practice Address - Phone:423-479-2854
Practice Address - Fax:423-479-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000002113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty