Provider Demographics
NPI:1376835306
Name:MCCULLOUGH, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 BAYSHORE RD
Mailing Address - Street 2:UNIT B-1
Mailing Address - City:NORTH CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-3772
Mailing Address - Country:US
Mailing Address - Phone:609-972-5427
Mailing Address - Fax:
Practice Address - Street 1:1 MUNRO AVE
Practice Address - Street 2:TRACEN CAPE MAY
Practice Address - City:CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-5000
Practice Address - Country:US
Practice Address - Phone:609-898-6960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22HI00822400124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist