Provider Demographics
NPI:1801220538
Name:MCCULLOUGH, PAMELA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:R
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-3442
Mailing Address - Country:US
Mailing Address - Phone:316-283-0870
Mailing Address - Fax:
Practice Address - Street 1:229 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3442
Practice Address - Country:US
Practice Address - Phone:316-283-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS6191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist