Provider Demographics
NPI:1568633931
Name:DR. GARY L. MCCORD
Entity Type:Organization
Organization Name:DR. GARY L. MCCORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-735-3114
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41004-0267
Mailing Address - Country:US
Mailing Address - Phone:606-735-3114
Mailing Address - Fax:606-735-3114
Practice Address - Street 1:224 FRANKFORT STREET
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41004
Practice Address - Country:US
Practice Address - Phone:606-735-3114
Practice Address - Fax:606-735-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty