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General NPI Number Information
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NPI Number | 1891357067
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Entity Type | Organization
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Legal Business Name | COTTRELL AND MCCULLOUGH DENTAL PLLC
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 36 HOMER AVE
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City | QUEENSBURY
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State | NY
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Zip | 12804-2009
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Country | US
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Telephone | 518-793-1345
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Fax |
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Provider Business Mailing Address
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Address Line | 36 HOMER AVE
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City | QUEENSBURY
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State | NY
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Zip | 12804-2009
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Country | US
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Telephone | 518-793-1345
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Fax |
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | CARLY MCCULLOUGH
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Credential | DDS
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Telephone | 518-793-1345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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