Provider Demographics
NPI:1235677840
Name:MCCUE DENTAL FULTON PC
Entity Type:Organization
Organization Name:MCCUE DENTAL FULTON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCCUE
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-779-2222
Mailing Address - Street 1:41 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1724
Mailing Address - Country:US
Mailing Address - Phone:315-779-2222
Mailing Address - Fax:
Practice Address - Street 1:41 S 2ND ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1724
Practice Address - Country:US
Practice Address - Phone:315-779-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03085949Medicaid