Provider Demographics
NPI:1942228754
Name:MCCOY, THOMAS DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DAVID
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 1:825 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1838
Mailing Address - Country:US
Mailing Address - Phone:563-927-5415
Mailing Address - Fax:563-927-3542
Practice Address - Street 1:825 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1838
Practice Address - Country:US
Practice Address - Phone:563-927-5415
Practice Address - Fax:563-927-3542
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA75641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice