Healthcare Provider Details

I. General information

NPI: 1205996428
Provider Name (Legal Business Name): RAY MICHAEL MCCULLOUGH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7551 FOREST OAKS BLVD
SPRING HILL FL
34606-2437
US

IV. Provider business mailing address

29743 CHAPEL PARK DR
WESLEY CHAPEL FL
33543-4491
US

V. Phone/Fax

Practice location:
  • Phone: 352-518-2000
  • Fax:
Mailing address:
  • Phone: 813-849-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17434
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN17434
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: