Healthcare Provider Details

I. General information

NPI: 1598892317
Provider Name (Legal Business Name): JAMES MICHAEL MCCORMICK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 HIGHWAY 80
HAUGHTON LA
71037-7405
US

IV. Provider business mailing address

2900 HIGHWAY 80
HAUGHTON LA
71037-7405
US

V. Phone/Fax

Practice location:
  • Phone: 318-949-1771
  • Fax: 318-949-1774
Mailing address:
  • Phone: 318-949-1771
  • Fax: 318-949-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3981
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: