Provider Demographics
NPI:1588739239
Name:MCCOY, MARK C (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:MCCOY
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 MILE STRETCH DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690
Mailing Address - Country:US
Mailing Address - Phone:727-938-2866
Mailing Address - Fax:727-938-2867
Practice Address - Street 1:6824 VALHALLA WAY
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5626
Practice Address - Country:US
Practice Address - Phone:407-417-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0014147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist