Provider Demographics
NPI:1669562856
Name:MCCORD, TAMMY P (DMD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:P
Last Name:MCCORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 PROFESSIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391
Mailing Address - Country:US
Mailing Address - Phone:859-744-0238
Mailing Address - Fax:859-744-0251
Practice Address - Street 1:122 PROFESSIONAL AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391
Practice Address - Country:US
Practice Address - Phone:859-744-0238
Practice Address - Fax:859-744-0251
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59971223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist