Provider Demographics
NPI:1467893347
Name:GEORGE A. MCCULLY DMD PC
Entity Type:Organization
Organization Name:GEORGE A. MCCULLY DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:MCCULLY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-485-1444
Mailing Address - Street 1:622 E 22ND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2989
Mailing Address - Country:US
Mailing Address - Phone:541-485-1444
Mailing Address - Fax:541-485-1445
Practice Address - Street 1:622 E 22ND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2989
Practice Address - Country:US
Practice Address - Phone:541-485-1444
Practice Address - Fax:541-485-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental