Individual
MICHAEL PATRICK MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1700 SUMMIT AVE, RED OAK, IA 51566
(712) 623-4988
(712) 623-5231
Mailing address
1700 SUMMIT AVE, RED OAK, IA 51566
(712) 623-4988
(712) 623-5231
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7697
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105510
—
IA
Enumeration date
08/14/2006
Last updated
07/08/2007
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