Provider Demographics
NPI:1366435711
Name:MCCORD, PAUL THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:MCCORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 CHAMBLISS AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3874
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:37311-3874
Practice Address - Country:US
Practice Address - Phone:423-479-8544
Practice Address - Fax:423-479-1444
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32971223S0112X
TNDS32971223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2009217OtherBCBS TN
TN439950OtherUNITED CONCORDIA
TN2009217OtherBCBS TN
TNT74063Medicare UPIN