Healthcare Provider Details

I. General information

NPI: 1689509317
Provider Name (Legal Business Name): AUSTIN MCCULLOUGH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 QUINCY ST STE 103
RAPID CITY SD
57701-8230
US

IV. Provider business mailing address

3144 JOHNSTON CT
RAPID CITY SD
57703-6476
US

V. Phone/Fax

Practice location:
  • Phone: 218-849-4128
  • Fax:
Mailing address:
  • Phone: 218-849-4128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN MCCULLOUGH
Title or Position: DENTIST
Credential: DDS
Phone: 218-849-4128