MEDICARE: DR. CHRISTOPHER ROBERT CULLITON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5070	LA

General Provider Information

NPI Number	:	1467427989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER ROBERT CULLITON D.D.S.

Provider Business Mailing Address
First Line	:	1613 JIMMIE DAVIS HWY
Second Line	:	SUITE 1
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-4557
Country	:	US
Telephone Number	:	318-752-3939
Fax Number	:	318-752-3330

Provider Business Practice Location Address
First Line	:	1613 JIMMIE DAVIS HWY
Second Line	:	SUITE 1
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-4557
Country	:	US
Telephone Number	:	318-752-3939
Fax Number	:	318-752-3330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2006
Last Update Date	:	04/25/2017

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