Provider Demographics
NPI:1619241742
Name:MCCOY, KEVIN GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GERALD
Last Name:MCCOY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 95TH DR NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7975
Mailing Address - Country:US
Mailing Address - Phone:425-512-9887
Mailing Address - Fax:
Practice Address - Street 1:22 95TH DR NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-7975
Practice Address - Country:US
Practice Address - Phone:425-512-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602919911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry