Provider Demographics
NPI:1518397579
Name:KARA MCCULLOCH DMD MSD PLLC
Entity Type:Organization
Organization Name:KARA MCCULLOCH DMD MSD PLLC
Other - Org Name:ORTHODONTIC ASSOCIATES OF MERCER ISLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCULLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:206-232-9600
Mailing Address - Street 1:2817 80TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2913
Mailing Address - Country:US
Mailing Address - Phone:206-232-9600
Mailing Address - Fax:206-232-2936
Practice Address - Street 1:2817 80TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2913
Practice Address - Country:US
Practice Address - Phone:206-232-9600
Practice Address - Fax:206-232-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7844385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care