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Individual

SHAWN TIMOTHY MCCULLOUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
6041 MAIN STREET, SUITE C, NORTH BRANCH, MN 55056
(651) 674-4811
(651) 277-0411
Mailing address
PO BOX 40, 6041 MAIN STREET SUITE C, NORTH BRANCH, MN 55056
(651) 674-4811
(651) 277-0411

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
011245
MN

Other

Enumeration date
12/19/2006
Last updated
07/08/2007
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