Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 3622 | ME |
NPI | 1093920860 |
---|---|
Provider Name | Dr. Michael J. Mccoy |
First Address | Scarborough, ME 04074-9701 |
Second Address | Scarborough, ME 04074-9701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 09/07/2007 |