Provider Demographics
NPI:1124175351
Name:GARY E. MCCORD D.D.S., P.A.
Entity type:Organization
Organization Name:GARY E. MCCORD D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-825-5111
Mailing Address - Street 1:1215 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3371
Mailing Address - Country:US
Mailing Address - Phone:704-825-5111
Mailing Address - Fax:704-825-5113
Practice Address - Street 1:1215 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3371
Practice Address - Country:US
Practice Address - Phone:704-825-5111
Practice Address - Fax:704-825-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC48611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty