Healthcare Provider Details

I. General information

NPI: 1366435711
Provider Name (Legal Business Name): PAUL THOMAS MCCORD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 PEERLESS CROSSING NW
CLEVELAND TN
37312
US

IV. Provider business mailing address

1015 PEERLESS CROSSING NW
CLEVELAND TN
37312
US

V. Phone/Fax

Practice location:
  • Phone: 423-479-8544
  • Fax: 423-479-1444
Mailing address:
  • Phone: 423-479-8544
  • Fax: 423-479-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS3297
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3297
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: