=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689978934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAELA M. MCCORMICK, DMD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2010
-----------------------------------------------------
Last Update Date | 12/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2215 BALTIMORE PIKE
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19363-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-932-2917
-----------------------------------------------------
Fax | 610-932-7858
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2215 BALTIMORE PIKE
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19363-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-932-2917
-----------------------------------------------------
Fax | 610-932-7858
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAELA M MCCORMICK
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 610-932-2917
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DS036581
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------