Provider Demographics
NPI:1083622971
Name:MCCULLUM, WILLIE JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:JAMES
Last Name:MCCULLUM
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 1:4002 SOUTH 'M' STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418
Mailing Address - Country:US
Mailing Address - Phone:253-474-0606
Mailing Address - Fax:253-476-3901
Practice Address - Street 1:4002 SOUTH 'M' STREET
Practice Address - Street 2:SUITE A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418
Practice Address - Country:US
Practice Address - Phone:253-474-0606
Practice Address - Fax:253-476-3901
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist