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General NPI Number Information
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NPI Number | 1962554428
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Entity Type | Individual
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Provider Name | SUZANNE U MCCORMICK MS, DDS
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 355 SANTA FE DR SUITE100
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City | ENCINITAS
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State | CA
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Zip | 92024-5132
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Country | US
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Telephone | 760-753-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 355 SANTA FE DR SUITE100
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City | ENCINITAS
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State | CA
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Zip | 92024-5132
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Country | US
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Telephone | 760-753-5300
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 50704
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 042762
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2867
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License Number State | WV
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