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General NPI Number Information
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NPI Number | 1962830232
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Entity Type | Individual
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Provider Name | JOHN B MCCOLLUM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 10/24/2013
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Provider Practice Location Address
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Address Line | 110 S. IDAHO STREET
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City | DILLON
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State | MT
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Zip | 59725
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Country | US
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Telephone | 406-683-5125
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Fax | 406-683-5126
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Provider Business Mailing Address
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Address Line | P.O. BOX 1255 110 S.
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City | DILLON
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State | MT
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Zip | 59725
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Country | US
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Telephone | 406-683-5125
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Fax | 406-683-5126
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 1108
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License Number State | MT
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