Provider Demographics
NPI:1740670868
Name:MCCARTY, CYNTHIA KATHLEEN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KATHLEEN
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MOREL CT
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-9641
Mailing Address - Country:US
Mailing Address - Phone:541-601-7497
Mailing Address - Fax:541-879-1111
Practice Address - Street 1:4 MOREL CT
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-9641
Practice Address - Country:US
Practice Address - Phone:541-601-7497
Practice Address - Fax:541-879-1111
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4120124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist