Healthcare Provider Details

I. General information

NPI: 1578747572
Provider Name (Legal Business Name): JASON T. CULLEY D.D.S. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 DUBLIN RD
COLUMBUS OH
43215-1024
US

IV. Provider business mailing address

1225 DUBLIN RD
COLUMBUS OH
43215-1024
US

V. Phone/Fax

Practice location:
  • Phone: 614-488-9050
  • Fax: 614-488-9120
Mailing address:
  • Phone: 614-488-9050
  • Fax: 614-488-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.021745
License Number StateOH

VIII. Authorized Official

Name: DR. JASON T. CULLEY
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 614-488-9050