Healthcare Provider Details

I. General information

NPI: 1205098217
Provider Name (Legal Business Name): DENNIS J. MCCOY, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 CARL ST
SAINT CLAIR MO
63077-1601
US

IV. Provider business mailing address

1085 CARL ST
SAINT CLAIR MO
63077-1601
US

V. Phone/Fax

Practice location:
  • Phone: 636-629-1952
  • Fax:
Mailing address:
  • Phone: 636-629-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number012720
License Number StateMO

VIII. Authorized Official

Name: DR. DENNIS J. MC COY
Title or Position: PRESIDENT
Credential: DDS
Phone: 636-629-1952