Provider Demographics
NPI:1366742892
Name:MCCOY, BRUCE PATRICK (DMD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:PATRICK
Last Name:MCCOY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2959 HIGHWAY 154
Mailing Address - Street 2:BUILDING C, SUITE A
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2297
Mailing Address - Country:US
Mailing Address - Phone:770-304-0333
Mailing Address - Fax:770-304-2281
Practice Address - Street 1:2959 HIGHWAY 154
Practice Address - Street 2:BUILDING C, SUITE A
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2297
Practice Address - Country:US
Practice Address - Phone:770-304-0333
Practice Address - Fax:770-304-2281
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0093591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics