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General NPI Number Information
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NPI Number | 1578117339
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Entity Type | Individual
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Provider Name | ALEX MCCOY DANIEL DMD
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Gender | Male
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 6215 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61108-2514
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Country | US
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Telephone | 815-399-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 351 HAMPSTEAD DR
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City | SUGAR GROVE
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State | IL
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Zip | 60554-2206
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Country | US
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Telephone | 630-608-7428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.032375
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License Number State | IL
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