Provider Demographics
NPI:1891143178
Name:MCCORMACK, KEVIN M (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:MCCORMACK
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 1:5650 ARGONNE ST APT 12303
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8866
Mailing Address - Country:US
Mailing Address - Phone:812-322-8066
Mailing Address - Fax:
Practice Address - Street 1:18240 E 104TH AVE UNIT 201
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-0660
Practice Address - Country:US
Practice Address - Phone:303-928-7838
Practice Address - Fax:216-584-1363
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002043711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice