Active NPI
Gabriel I McCormick, DMD
- Dentist
- Missoula, MT
National Provider Identifier
1700072113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2343
- Practice address
- 401 Railroad St W
Missoula, MT 59802-4109 - Phone
- (406) 258-4153
- Fax
- (406) 258-4180
- NPI assigned
- Sep 19, 2007
- Last updated
- Apr 1, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2343 | MT | Primary |
| General Practice Dentistry | 1223G0001X | D7391 | AZ |
Addresses
Primary practice location
401 Railroad St W
Missoula, MT 59802-4109
Mailing address
401 Railroad St W
Missoula, MT 59802-4109
Phone (406) 258-4153
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D7391 | AZ | MD | General Practice Dentistry |
| 2343 | MT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270080000000",
"number": "1700072113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 RAILROAD ST W",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598024109",
"telephone_number": "406-258-4153",
"fax_number": "406-258-4180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 RAILROAD ST W",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598024109",
"telephone_number": "406-258-4153",
"fax_number": "406-258-4180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMICK",
"first_name": "GABRIEL",
"middle_name": "I",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-19",
"last_updated": "2010-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MT",
"license": "2343",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "D7391",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.