MEDICARE: AUSTIN MCCULLOUGH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1689509317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN MCCULLOUGH LLC

Provider Business Mailing Address
First Line	:	3144 JOHNSTON CT
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-6476
Country	:	US
Telephone Number	:	218-849-4128
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 QUINCY ST STE 103
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-8230
Country	:	US
Telephone Number	:	218-849-4128
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	AUSTIN MCCULLOUGH
Credential	:	DDS
Telephone Number	:	218-849-4128

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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