Provider Demographics
NPI:1982016523
Name:JENNIFER MCCOY DDS LAWRENCEVILLE, LLC
Entity Type:Organization
Organization Name:JENNIFER MCCOY DDS LAWRENCEVILLE, LLC
Other - Org Name:JENNIFER L MCCOY DDS COSMETIC AND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-665-1366
Mailing Address - Street 1:365 W PIKE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3205
Mailing Address - Country:US
Mailing Address - Phone:770-963-2424
Mailing Address - Fax:
Practice Address - Street 1:365 W PIKE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3205
Practice Address - Country:US
Practice Address - Phone:770-963-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty