Individual
DR. SUEZAN C. MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
115 HWY 556, MEADVILLE, MS 39653
(601) 384-5891
(601) 384-5878
Mailing address
PO BOX 758, MEADVILLE, MS 39653-0758
(601) 384-5891
(601) 384-5878
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
262691
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00060449
—
MS
Enumeration date
01/16/2007
Last updated
07/08/2007
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