Provider Demographics
NPI:1013099894
Name:MCCORMICK, MICHAEL P JR (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:MCCORMICK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:901 ENTERPRISE PKWY STE 500
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6253
Mailing Address - Country:US
Mailing Address - Phone:757-896-4900
Mailing Address - Fax:757-896-4905
Practice Address - Street 1:901 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6249
Practice Address - Country:US
Practice Address - Phone:757-896-4900
Practice Address - Fax:757-896-4905
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA87461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA986085OtherUNITED CONCORDIA
VA285011OtherBLUE CROSS BLUE SHIELD