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General NPI Number Information
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NPI Number | 1689744831
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Entity Type | Individual
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Provider Name | DANIEL RAY CULLUM DDS
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1859 N LAKEWOOD DR SUITE 101
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2661
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Country | US
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Telephone | 208-667-5565
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Fax | 208-765-9633
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Provider Business Mailing Address
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Address Line | 1859 N LAKEWOOD DR SUITE 101
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2661
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Country | US
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Telephone | 208-667-5565
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Fax | 208-765-9633
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D3149-0S
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License Number State | ID
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