Provider Demographics
NPI:1215052246
Name:MCCANN, MICHAEL SCOT (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOT
Last Name:MCCANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3769 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3327
Mailing Address - Country:US
Mailing Address - Phone:252-443-0048
Mailing Address - Fax:252-443-4796
Practice Address - Street 1:105 WAYFARER CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-6282
Practice Address - Country:US
Practice Address - Phone:252-443-0048
Practice Address - Fax:252-443-4796
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83471223G0001X
VA040100-66041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215052246OtherNPI
NC5906483Medicaid