Provider Demographics
NPI:1063420040
Name:MCCORMICK FAMILY DENTAL CARE SC
Entity type:Organization
Organization Name:MCCORMICK FAMILY DENTAL CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-233-5351
Mailing Address - Street 1:5610 MEDICAL CIRCLE
Mailing Address - Street 2:STE 10
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719
Mailing Address - Country:US
Mailing Address - Phone:608-233-5351
Mailing Address - Fax:608-238-6777
Practice Address - Street 1:5610 MEDICAL CIRCLE
Practice Address - Street 2:STE 10
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-233-5351
Practice Address - Fax:608-238-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty