Provider Demographics
NPI:1760956619
Name:MADISON CULLER, D.M.D., P.A.
Entity Type:Organization
Organization Name:MADISON CULLER, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:CULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-884-5161
Mailing Address - Street 1:211 SIMMONS STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29412
Mailing Address - Country:US
Mailing Address - Phone:843-884-5161
Mailing Address - Fax:843-352-7409
Practice Address - Street 1:211 SIMMONS STREET
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-884-5161
Practice Address - Fax:843-352-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty