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General NPI Number Information
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NPI Number | 1629110705
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Entity Type | Individual
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Provider Name | PATRICK HAROLD MCCULLOUGH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1037 STATE ROUTE 196
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City | HUDSON FALLS
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State | NY
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Zip | 12839-2168
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Country | US
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Telephone | 518-747-9527
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Fax | 518-747-6151
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Provider Business Mailing Address
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Address Line | 13 TRIPHAMMER RD
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City | QUEENSBURY
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State | NY
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Zip | 12804-8064
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Country | US
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Telephone | 518-798-3186
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Fax | 518-798-3186
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 033428
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License Number State | NY
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