| Willie Mclullum Dds - Children's Dentistry | |
|
4002 South M Street Suite A Tacoma WA 98418 | |
| (253) 474-0606 | |
| Not Available |
| Full Name | Willie Mclullum Dds - Children's Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4002 South M Street, Tacoma, Washington |
| Authorized Official Name and Position | Willie James Mccullum (DENTIST/OWNER) |
| Authorized Official Contact | 2534740606 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willie Mclullum Dds - Children's Dentistry 4002 South M Street Suite A Tacoma WA 98418 Ph: (253) 474-0606 | Willie Mclullum Dds - Children's Dentistry 4002 South M Street Suite A Tacoma WA 98418 Ph: (253) 474-0606 |
| NPI Number | 1407166655 |
|---|---|
| Provider Enumeration Date | 10/20/2010 |
| Last Update Date | 12/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407166655 | NPI | - | NPPES |
| 5050273 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 6326 (Washington) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | 8920 (Washington) | Secondary |
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