Provider Demographics
NPI:1609432798
Name:CHRISTINA MCCULLOUGH DDS PLLC
Entity Type:Organization
Organization Name:CHRISTINA MCCULLOUGH DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-471-9205
Mailing Address - Street 1:2455 SHADYWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:MN
Mailing Address - Zip Code:55331
Mailing Address - Country:US
Mailing Address - Phone:952-471-9205
Mailing Address - Fax:952-471-0496
Practice Address - Street 1:2455 SHADYWOOD ROAD
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:MN
Practice Address - Zip Code:55331
Practice Address - Country:US
Practice Address - Phone:952-471-9205
Practice Address - Fax:952-471-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty