Individual
YETTA G MCCULLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MA
Contact information
Practice address
820 E 87TH ST, STE 201, CHICAGO, IL 60619-6253
(773) 488-3738
(773) 874-6575
Mailing address
820 E 87TH ST, STE 201, CHICAGO, IL 60619-6253
(773) 488-3738
(773) 874-6575
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
021001516
IL
Other
Enumeration date
09/22/2008
Last updated
09/23/2008
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