Provider Demographics
NPI:1275797425
Name:MCCOY, BRADLEY RAYMOND (DDS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:RAYMOND
Last Name:MCCOY
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 1:306 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-1676
Mailing Address - Country:US
Mailing Address - Phone:616-794-2430
Mailing Address - Fax:616-794-2834
Practice Address - Street 1:306 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809-1676
Practice Address - Country:US
Practice Address - Phone:616-794-2430
Practice Address - Fax:616-794-2834
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010137821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice