Provider Demographics
NPI:1205066545
Name:MCCOO, ADRIAN NITARA (RDH, BS)
Entity type:Individual
Prefix:MRS
First Name:ADRIAN
Middle Name:NITARA
Last Name:MCCOO
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:MRS
Other - First Name:ADRIAN
Other - Middle Name:NITARA
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH, BS
Mailing Address - Street 1:9200 WHITE SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-2028
Mailing Address - Country:US
Mailing Address - Phone:817-246-2721
Mailing Address - Fax:817-246-0429
Practice Address - Street 1:9200 WHITE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-2028
Practice Address - Country:US
Practice Address - Phone:817-246-2721
Practice Address - Fax:817-246-0429
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15356124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist