Provider Demographics
NPI:1710607874
Name:EXCELLENCE IN DENTISTRY, LLC
Entity Type:Organization
Organization Name:EXCELLENCE IN DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-599-4133
Mailing Address - Street 1:1001 N SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4232
Mailing Address - Country:US
Mailing Address - Phone:608-240-1001
Mailing Address - Fax:
Practice Address - Street 1:1001 N SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4232
Practice Address - Country:US
Practice Address - Phone:608-240-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental