Provider Demographics
NPI:1114920865
Name:MCCORKLE, ALLEN DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DOUGLAS
Last Name:MCCORKLE
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 1:1829 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6365
Mailing Address - Country:US
Mailing Address - Phone:540-667-4880
Mailing Address - Fax:540-667-4881
Practice Address - Street 1:1829 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6365
Practice Address - Country:US
Practice Address - Phone:540-667-4880
Practice Address - Fax:540-667-4881
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010049001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry