Individual
DR. DAVID MARK MCCOLLOUGH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD MS
Contact information
Practice address
3750 CHEMAWA RD NE, CHEMAWA INDIAN HEALTH CENTER, SALEM, OR 97305-1111
(503) 304-7600
(503) 304-7677
Mailing address
3750 CHEMAWA RD NE, SALEM, OR 97305-1111
(503) 304-7664
(503) 304-7677
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4022
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278159
—
OR
Enumeration date
06/15/2006
Last updated
07/08/2007
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