Provider Demographics
NPI:1184714545
Name:MCCULLA, ROBERT ALEN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALEN
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 1:990 DELBON AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2019
Mailing Address - Country:US
Mailing Address - Phone:209-667-7889
Mailing Address - Fax:209-667-4712
Practice Address - Street 1:990 DELBON AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2019
Practice Address - Country:US
Practice Address - Phone:209-667-7889
Practice Address - Fax:209-667-4712
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADB0313261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice