Provider Demographics
NPI:1245279710
Name:MCCORMICK, MICHAEL COOPER (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:COOPER
Last Name:MCCORMICK
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 1:820 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6786
Mailing Address - Country:US
Mailing Address - Phone:724-453-0809
Mailing Address - Fax:
Practice Address - Street 1:2015 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1928
Practice Address - Country:US
Practice Address - Phone:724-658-1681
Practice Address - Fax:724-658-8851
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030011L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice