Provider Demographics
NPI:1619166840
Name:DR. RANDY MCCORMICK, P.C., INC.
Entity Type:Organization
Organization Name:DR. RANDY MCCORMICK, P.C., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:S,
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-743-2346
Mailing Address - Street 1:5505 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6821
Mailing Address - Country:US
Mailing Address - Phone:918-743-2346
Mailing Address - Fax:918-743-3166
Practice Address - Street 1:5505 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6821
Practice Address - Country:US
Practice Address - Phone:918-743-2346
Practice Address - Fax:918-743-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty