Provider Demographics
NPI:1467833210
Name:TOM MCCUE IV DDS PC
Entity Type:Organization
Organization Name:TOM MCCUE IV DDS PC
Other - Org Name:MCCUE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCCUE
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-779-2222
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:9651 BREWERTON RD
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-9704
Mailing Address - Country:US
Mailing Address - Phone:315-676-7900
Mailing Address - Fax:
Practice Address - Street 1:9651 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-9704
Practice Address - Country:US
Practice Address - Phone:315-676-7900
Practice Address - Fax:315-785-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty