Provider Demographics
NPI:1467543439
Name:MCCOY, EUGENE DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:DONALD
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 1:1390 MARKET ST
Mailing Address - Street 2:SUITE 226
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5402
Mailing Address - Country:US
Mailing Address - Phone:415-621-5471
Mailing Address - Fax:415-621-5040
Practice Address - Street 1:1390 MARKET ST
Practice Address - Street 2:SUITE 226
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5402
Practice Address - Country:US
Practice Address - Phone:415-621-5471
Practice Address - Fax:415-621-5040
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice