Individual
ALEX MCCOY DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
6215 E STATE ST, ROCKFORD, IL 61108-2514
(815) 399-7777
Mailing address
351 HAMPSTEAD DR, SUGAR GROVE, IL 60554-2206
(630) 608-7428
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.032375
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/30/2019
Last updated
09/03/2019
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