# DR. DANIEL R CULLUM PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Implants Northwest
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386020550
- **Authorized official:** DR. DANIEL CULLUM DDS (PRESIDENT)
- **Authorized official phone:** (208) 667-5565

## Contact information

- **Practice address:** 1859 N LAKEWOOD DR, STE 101, COEUR D ALENE, ID 83814-2661
- **Practice address phone:** (208) 667-5565
- **Practice address fax:** (208) 765-9633
- **Mailing address:** 1859 N LAKEWOOD DR, STE 101, COEUR D ALENE, ID 83814-2661
- **Mailing address phone:** (208) 667-5565
- **Mailing address fax:** (208) 765-9633

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | D-3149-OS | ID | Yes |

## Other

- **Enumeration date:** 08/10/2015
- **Last updated:** 08/10/2015