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General NPI Number Information
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NPI Number | 1982016523
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Entity Type | Organization
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Legal Business Name | JENNIFER MCCOY DDS LAWRENCEVILLE, LLC
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 365 W PIKE ST
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3205
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Country | US
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Telephone | 770-963-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 365 W PIKE ST
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3205
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Country | US
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Telephone | 770-963-2424
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JENNIFER LYNN MCCOY
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Credential | DDS
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Telephone | 562-665-1366
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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 | DN013561
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License Number State | GA
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