Provider Demographics
NPI:1427058445
Name:MCCULLOCH, EDWARD J (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:MCCULLOCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3585 VAN TEYLINGEN DR
Mailing Address - Street 2:STE F
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-4875
Mailing Address - Country:US
Mailing Address - Phone:719-597-7111
Mailing Address - Fax:719-572-0177
Practice Address - Street 1:3585 VAN TEYLINGEN DR
Practice Address - Street 2:STE F
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-4875
Practice Address - Country:US
Practice Address - Phone:719-597-7111
Practice Address - Fax:719-572-0177
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1047171223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health