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Organization
WJM DENTAL INC
Active
Organization
WJM DENTAL INC
Active
Other names
Willie McLullum DDS - Children's Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIE JAMES MCCULLUM D.D.S. (DENTIST/OWNER)
(253) 474-0606
Entity
Organization
Contact information
Practice address
4002 SOUTH M STREET, SUITE A, TACOMA, WA 98418
(253) 474-0606
Mailing address
4002 SOUTH M STREET, SUITE A, TACOMA, WA 98418
(253) 474-0606
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6326
WA
1223P0221X
Pediatric Dentistry
8920
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5050273
—
WA
Enumeration date
10/20/2010
Last updated
12/18/2012
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