Individual
DR. MICHAEL SHAWN MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2573 STATE HIGHWAY 522, QUESTA, NM 87556-0290
(575) 586-0315
(505) 443-8353
Mailing address
2573 STATE HIGHWAY 522, QUESTA, NM 87556-0290
(575) 586-0315
(505) 443-8353
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
DE61574138
WA
1223G0001X
General Practice Dentistry
00201972
CO
1223G0001X
General Practice Dentistry
Primary
DB-2026-0084
NM
1223G0001X
General Practice Dentistry
DD5553
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500624011
—
OR
05
—
78337372
—
CO
Enumeration date
07/14/2010
Last updated
06/19/2026
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