Healthcare Provider Details

I. General information

NPI: 1669562856
Provider Name (Legal Business Name): TAMMY P MCCORD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 PROFESSIONAL AVE
WINCHESTER KY
40391
US

IV. Provider business mailing address

122 PROFESSIONAL AVE
WINCHESTER KY
40391
US

V. Phone/Fax

Practice location:
  • Phone: 859-744-0238
  • Fax: 859-744-0251
Mailing address:
  • Phone: 859-744-0238
  • Fax: 859-744-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5997
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5997
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: