Provider Demographics
NPI:1588206098
Name:MCCORMICK, ALICE ELIZABETH
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:ELIZABETH
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15401 CHENAL PKWY APT 4214
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2579
Mailing Address - Country:US
Mailing Address - Phone:601-764-7245
Mailing Address - Fax:
Practice Address - Street 1:2000 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-3600
Practice Address - Country:US
Practice Address - Phone:501-588-7688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR43771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice