Provider Demographics
NPI:1609114487
Name:THOMAS PATRICK MCCUE IV DDS PC
Entity Type:Organization
Organization Name:THOMAS PATRICK MCCUE IV DDS PC
Other - Org Name:MCCUE DNTAL
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 1:20 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-4403
Mailing Address - Country:US
Mailing Address - Phone:315-779-2222
Mailing Address - Fax:
Practice Address - Street 1:20 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:NY
Practice Address - Zip Code:13142-4403
Practice Address - Country:US
Practice Address - Phone:315-779-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03085949Medicaid