MEDICARE: DR. PAUL THOMAS MCCORD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	DS3297	TN
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	3297	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	439950	OTHER	TN	UNITED CONCORDIA
2	2009217	OTHER	TN	BCBS TN

General Provider Information

NPI Number	:	1366435711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL THOMAS MCCORD DDS

Provider Business Mailing Address
First Line	:	1015 PEERLESS CROSSING NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312
Country	:	US
Telephone Number	:	423-479-8544
Fax Number	:	423-479-1444

Provider Business Practice Location Address
First Line	:	1015 PEERLESS CROSSING NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312
Country	:	US
Telephone Number	:	423-479-8544
Fax Number	:	423-479-1444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	06/19/2025

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