Provider Demographics
NPI:1538338579
Name:OCOEE ORAL SURGERY PC
Entity type:Organization
Organization Name:OCOEE ORAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-479-8544
Mailing Address - Street 1:2222 CHAMBLISS AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3895
Mailing Address - Country:US
Mailing Address - Phone:423-479-8544
Mailing Address - Fax:423-479-1444
Practice Address - Street 1:2222 CHAMBLISS AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3895
Practice Address - Country:US
Practice Address - Phone:423-479-8544
Practice Address - Fax:423-479-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS32971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty