Provider Demographics
NPI:1285824938
Name:MCCORMICK, MARK C (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W. ARAPAHO RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:972-231-5020
Mailing Address - Fax:972-231-5950
Practice Address - Street 1:516 W. ARAPAHO RD #103
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:928-636-1565
Practice Address - Fax:928-636-1164
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD69971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice