Individual
DR. MATT MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
3411 MERLIN DR, IDAHO FALLS, ID 83404-7430
(801) 440-6849
Mailing address
596 TAYLOR LN, CHUBBUCK, ID 83202-2380
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D4719
ID
Other
Enumeration date
01/04/2016
Last updated
01/04/2016
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