Provider Demographics
NPI:1104064559
Name:MCCULLOUGH AND STEVENS
Entity type:Organization
Organization Name:MCCULLOUGH AND STEVENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:ADAMA
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-218-9823
Mailing Address - Street 1:4643 CAMP COLEMAN RD STE 125
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2838
Mailing Address - Country:US
Mailing Address - Phone:205-218-9823
Mailing Address - Fax:
Practice Address - Street 1:4643 CAMP COLEMAN RD STE 125
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2838
Practice Address - Country:US
Practice Address - Phone:205-218-9823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty