Provider Demographics
NPI:1245230374
Name:DR PAMELA R MCCULLOUGH DDS PA
Entity Type:Organization
Organization Name:DR PAMELA R MCCULLOUGH DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-283-0870
Mailing Address - Street 1:229 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-3442
Mailing Address - Country:US
Mailing Address - Phone:316-283-0870
Mailing Address - Fax:316-282-2500
Practice Address - Street 1:229 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3442
Practice Address - Country:US
Practice Address - Phone:316-283-0870
Practice Address - Fax:316-282-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty