Basic Information
| Provider Information | |||||||||
| NPI: | 1487052759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCULLOUGH | ||||||||
| FirstName: | TAMI | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | US ARMY DENTAL ACTIVITY BAVARIA | ||||||||
| Address2: | UNIT 28038 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 011499662834738 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | US ARMY DENTAL ACTIVITY BAVARIA | ||||||||
| Address2: | UNIT 28038 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 011499662834738 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2014 | ||||||||
| LastUpdateDate: | 12/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | DH22990 | FL | Y | Dental Providers | Dental Hygienist |
No ID Information.