Provider Demographics
NPI:1568651016
Name:JOHN D. O'CULL DENTISTRY P.S.C.
Entity Type:Organization
Organization Name:JOHN D. O'CULL DENTISTRY P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:O'CULL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-796-3811
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-0549
Mailing Address - Country:US
Mailing Address - Phone:606-796-3811
Mailing Address - Fax:606-796-2221
Practice Address - Street 1:RURAL ROUTE 3037
Practice Address - Street 2:
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179
Practice Address - Country:US
Practice Address - Phone:606-796-3811
Practice Address - Fax:606-796-2221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN D. O'CULL DENTISTRY P.S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5556122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61900619Medicaid