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General NPI Number Information
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NPI Number | 1427413194
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Entity Type | Organization
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Legal Business Name | MICHAEL S MCCORMICK DMD LLC
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 168 QUAKER RD
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City | EAST AURORA
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State | NY
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Zip | 14052-2101
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Country | US
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Telephone | 716-652-1140
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Fax | 716-655-4182
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Provider Business Mailing Address
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Address Line | 168 QUAKER RD
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City | EAST AURORA
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State | NY
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Zip | 14052-2101
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Country | US
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Telephone | 716-652-1140
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Fax | 716-655-4182
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MICHAEL SEAN MCCORMICK
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Credential | D.M.D.
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Telephone | 716-652-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 047306
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License Number State | NY
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