Organization
DR. DANIEL R CULLUM PA
Active
Other names
Implants Northwest
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL CULLUM DDS (PRESIDENT)
(208) 667-5565
Entity
Organization
Contact information
Practice address
1859 N LAKEWOOD DR, STE 101, COEUR D ALENE, ID 83814-2661
(208) 667-5565
(208) 765-9633
Mailing address
1859 N LAKEWOOD DR, STE 101, COEUR D ALENE, ID 83814-2661
(208) 667-5565
(208) 765-9633
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D-3149-OS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D-3149-OS
STATE LICENSE
ID
Enumeration date
08/10/2015
Last updated
08/10/2015
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