Provider Demographics
NPI:1760406508
Name:MCCULLA, PATRICK S (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
Last Name:MCCULLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 STOCKWELL ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5755
Mailing Address - Country:US
Mailing Address - Phone:402-421-7500
Mailing Address - Fax:402-421-7715
Practice Address - Street 1:2623 STOCKWELL ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5755
Practice Address - Country:US
Practice Address - Phone:402-421-7500
Practice Address - Fax:402-421-7715
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice