Provider Demographics
NPI:1720278476
Name:MCCOY, ROBERT H
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:MCCOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 REGENCY PLZ
Mailing Address - Street 2:SUITE 23
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1001
Mailing Address - Country:US
Mailing Address - Phone:610-358-5690
Mailing Address - Fax:610-358-2820
Practice Address - Street 1:871 BALTIMORE PIKE
Practice Address - Street 2:SUITE 23
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1001
Practice Address - Country:US
Practice Address - Phone:610-358-5690
Practice Address - Fax:610-358-2820
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020236L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice