Provider Demographics
NPI:1194748285
Name:CULLUM, PAUL EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:CULLUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6409
Mailing Address - Country:US
Mailing Address - Phone:931-381-7766
Mailing Address - Fax:931-381-2738
Practice Address - Street 1:105 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6409
Practice Address - Country:US
Practice Address - Phone:931-381-7766
Practice Address - Fax:931-381-2738
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS36611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3072215OtherBLUE CROSS BLUE SHIELD TN
TN909843OtherUNITED CONCORDIA
TN80-40025OtherUNITED HEALTHCARE
TN0010342OtherTENNCARE
TN909843OtherBLUE CROSS BLUE SHIELD PA
TN3225848Medicare ID - Type Unspecified
TNU29720Medicare UPIN