Individual
CARLY MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
36 HOMER AVE, QUEENSBURY, NY 12804-2009
(518) 793-1345
Mailing address
36 HOMER AVE, QUEENSBURY, NY 12804-2009
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
057908
NY
Other
Enumeration date
07/07/2014
Last updated
10/28/2015
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