Healthcare Provider Details

I. General information

NPI: 1366525164
Provider Name (Legal Business Name): GARY L. MCCORD D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 FRANKFORT ST
BROOKSVILLE KY
41004-8306
US

IV. Provider business mailing address

P.O BOX 267
BROOKSVILLE KY
41004
US

V. Phone/Fax

Practice location:
  • Phone: 606-735-3114
  • Fax: 606-735-3114
Mailing address:
  • Phone: 606-735-3114
  • Fax: 606-735-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5151
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: