Provider Demographics
NPI:1598710774
Name:MCCORMLEY, BENJAMIN JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:MCCORMLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12350 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1847
Mailing Address - Country:US
Mailing Address - Phone:724-863-1118
Mailing Address - Fax:
Practice Address - Street 1:1014 5TH AVE
Practice Address - Street 2:
Practice Address - City:EAST MC KEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15035-1312
Practice Address - Country:US
Practice Address - Phone:412-823-4909
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026435L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice