Healthcare Provider Details

I. General information

NPI: 1548610298
Provider Name (Legal Business Name): CAYLIN NICOLE MCCULLOUGH D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6877 DORCHESTER RD STE 11
NORTH CHARLESTON SC
29418-3700
US

IV. Provider business mailing address

530 LINGER LONGER DR UNIT 3309
JOHNS ISLAND SC
29455-3199
US

V. Phone/Fax

Practice location:
  • Phone: 843-212-4693
  • Fax:
Mailing address:
  • Phone: 816-273-6064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDGD.10476
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: