Provider Demographics
NPI:1396509808
Name:MCCOY, ANECIA (RDH)
Entity type:Individual
Prefix:MS
First Name:ANECIA
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4749 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9043
Mailing Address - Country:US
Mailing Address - Phone:910-330-9176
Mailing Address - Fax:
Practice Address - Street 1:4749 GORDON RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9043
Practice Address - Country:US
Practice Address - Phone:910-330-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03986124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist