Provider Demographics
NPI:1295807287
Name:MCCOY, PATRICK JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOHN
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 1:8299 161ST AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3860
Mailing Address - Country:US
Mailing Address - Phone:425-881-7574
Mailing Address - Fax:425-895-1289
Practice Address - Street 1:8299 161ST AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3860
Practice Address - Country:US
Practice Address - Phone:425-881-7574
Practice Address - Fax:425-895-1289
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000055251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice