MEDICARE: DR. BENJAMIN JOSEPH MCCORMLEY D.M.D.

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	1223G0001X	General Practice Dentistry	DS026435L	PA

General Provider Information

NPI Number	:	1598710774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN JOSEPH MCCORMLEY D.M.D.

Provider Business Mailing Address
First Line	:	12350 STATE ROUTE 30
Second Line	:
City	:	NORTH HUNTINGDON
State	:	PA
Zip	:	15642-1847
Country	:	US
Telephone Number	:	724-863-1118
Fax Number	:

Provider Business Practice Location Address
First Line	:	1014 5TH AVE
Second Line	:
City	:	EAST MC KEESPORT
State	:	PA
Zip	:	15035-1312
Country	:	US
Telephone Number	:	412-823-4909
Fax Number	:

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	12/31/2015

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