Provider Demographics
NPI:1497783245
Name:MCCOY, WAYNE DONNIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:DONNIE
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 1:1033 MADEIRA DR SE
Mailing Address - Street 2:APT. #101
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4632
Mailing Address - Country:US
Mailing Address - Phone:505-255-4686
Mailing Address - Fax:
Practice Address - Street 1:1501SAN PEDRO DR. SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-256-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA068251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice