Healthcare Provider Details

I. General information

NPI: 1376717322
Provider Name (Legal Business Name): DAVID M. MCCARTY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13710 STRUTHERS RD SUITE 200
COLORADO SPRINGS CO
80921-2467
US

IV. Provider business mailing address

13710 STRUTHERS RD SUITE 200
COLORADO SPRINGS CO
80921-2467
US

V. Phone/Fax

Practice location:
  • Phone: 719-344-8190
  • Fax: 719-358-6157
Mailing address:
  • Phone: 719-344-8190
  • Fax: 719-358-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9651
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS030834L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: