Provider Demographics
NPI:1407190028
Name:MCCOY, DELAINE COLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DELAINE
Middle Name:COLE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DELAINE
Other - Middle Name:
Other - Last Name:COLE-RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:26137 LA PAZ RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5325
Mailing Address - Country:US
Mailing Address - Phone:949-951-1067
Mailing Address - Fax:949-951-1407
Practice Address - Street 1:26137 LA PAZ RD STE 100
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5325
Practice Address - Country:US
Practice Address - Phone:949-951-1067
Practice Address - Fax:949-951-1407
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist