Provider Demographics
NPI:1326115361
Name:MCCOY, LARRY WENDELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WENDELL
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 1:907 HETHWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-4210
Mailing Address - Country:US
Mailing Address - Phone:540-552-4805
Mailing Address - Fax:540-552-0129
Practice Address - Street 1:907 HETHWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-4210
Practice Address - Country:US
Practice Address - Phone:540-552-4805
Practice Address - Fax:540-552-0129
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010073341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice