MEDICARE: JASON T. CULLEY D.D.S. INC

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	30.021745	OH

General Provider Information

NPI Number	:	1578747572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON T. CULLEY D.D.S. INC

Provider Business Mailing Address
First Line	:	1225 DUBLIN RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1024
Country	:	US
Telephone Number	:	614-488-9050
Fax Number	:	614-488-9120

Provider Business Practice Location Address
First Line	:	1225 DUBLIN RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1024
Country	:	US
Telephone Number	:	614-488-9050
Fax Number	:	614-488-9120

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JASON T. CULLEY
Credential	:	D.D.S.
Telephone Number	:	614-488-9050

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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