# WJM DENTAL INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Willie McLullum DDS - Children's Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407166655
- **Authorized official:** DR. WILLIE JAMES MCCULLUM D.D.S. (DENTIST/OWNER)
- **Authorized official phone:** (253) 474-0606

## Contact information

- **Practice address:** 4002 SOUTH M STREET, SUITE A, TACOMA, WA 98418
- **Practice address phone:** (253) 474-0606
- **Mailing address:** 4002 SOUTH M STREET, SUITE A, TACOMA, WA 98418
- **Mailing address phone:** (253) 474-0606

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6326 | WA | Yes |
| 1223P0221X | Pediatric Dentistry | 8920 | WA | — |

## Other

- **Enumeration date:** 10/20/2010
- **Last updated:** 12/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5050273 | — | WA |