Provider Demographics
NPI:1336428408
Name:T P MCCUE IV DDS PC
Entity Type:Organization
Organization Name:T P MCCUE IV DDS PC
Other - Org Name:THOMAS P MCCUE IV DDS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAMILLA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LYNDAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:315-779-2222
Mailing Address - Street 1:1116 ARSENAL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2229
Mailing Address - Country:US
Mailing Address - Phone:315-779-2222
Mailing Address - Fax:315-785-1080
Practice Address - Street 1:1116 ARSENAL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2229
Practice Address - Country:US
Practice Address - Phone:315-779-2222
Practice Address - Fax:315-785-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty