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General NPI Number Information
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NPI Number | 1972649200
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Entity Type | Organization
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Legal Business Name | DRS. MCCULLOM P.C.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 820 E 87TH ST SUITE 201
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City | CHICAGO
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State | IL
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Zip | 60619-6253
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Country | US
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Telephone | 773-488-3738
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Fax | 773-874-6575
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Provider Business Mailing Address
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Address Line | 820 E 87TH ST SUITE 201
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City | CHICAGO
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State | IL
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Zip | 60619-6253
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Country | US
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Telephone | 773-488-3738
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Fax | 773-874-6575
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Authorized Official
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Title or Position | VP AND CHEIF FINANICAL OFFICER
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Name | DR. YETTA G MCCULLOM
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Credential | DDS
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Telephone | 773-488-3738
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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