Provider Demographics
NPI:1972649200
Name:DRS. MCCULLOM P.C.
Entity Type:Organization
Organization Name:DRS. MCCULLOM P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AND CHEIF FINANICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:YETTA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCCULLOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-488-3738
Mailing Address - Street 1:820 E 87TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6253
Mailing Address - Country:US
Mailing Address - Phone:773-488-3738
Mailing Address - Fax:773-874-6575
Practice Address - Street 1:820 E 87TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6253
Practice Address - Country:US
Practice Address - Phone:773-488-3738
Practice Address - Fax:773-874-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty