Provider Demographics
NPI:1336669324
Name:MCCORMICK FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MCCORMICK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-229-3150
Mailing Address - Street 1:2320 STATE HIGHWAY 7 N
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-8170
Mailing Address - Country:US
Mailing Address - Phone:479-229-3150
Mailing Address - Fax:479-229-1177
Practice Address - Street 1:2320 STATE HIGHWAY 7 N
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-8170
Practice Address - Country:US
Practice Address - Phone:479-229-3150
Practice Address - Fax:479-229-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental