Provider Demographics
NPI:1699888370
Name:INMON, MACY F (DDS)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:F
Last Name:INMON
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:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:COOPER
Mailing Address - State:TX
Mailing Address - Zip Code:75432
Mailing Address - Country:US
Mailing Address - Phone:903-395-2137
Mailing Address - Fax:903-395-2404
Practice Address - Street 1:41 WEST SIDE SQUARE
Practice Address - Street 2:
Practice Address - City:COOPER
Practice Address - State:TX
Practice Address - Zip Code:75460
Practice Address - Country:US
Practice Address - Phone:903-395-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice