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General NPI Number Information
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NPI Number | 1346639457
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Entity Type | Organization
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Legal Business Name | DENTISTRY AT SIMPSONVILLE
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 1219 W GEORGIA RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-6335
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Country | US
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Telephone | 864-228-9112
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Fax | 864-228-9152
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Provider Business Mailing Address
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Address Line | 1219 W GEORGIA RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-6335
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Country | US
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Telephone | 864-228-9112
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Fax | 864-228-9152
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MARK J MCCOY
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Credential | D.M.D.
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Telephone | 864-228-9112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3610
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License Number State | SC
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