Provider Demographics
NPI:1962696187
Name:JOHN D.O'CULL DENTISTRY P.S.C.
Entity type:Organization
Organization Name:JOHN D.O'CULL DENTISTRY P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:O'CULL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-796-3811
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-0549
Mailing Address - Country:US
Mailing Address - Phone:606-796-3811
Mailing Address - Fax:606-796-2221
Practice Address - Street 1:ROUTE 3037
Practice Address - Street 2:
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179
Practice Address - Country:US
Practice Address - Phone:606-796-3811
Practice Address - Fax:606-796-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5556261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental