Individual
AUSTIN MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
921 S 8TH AVE STOP 8088, POCATELLO, ID 83209-0002
(208) 282-6000
Mailing address
856 E CARTER ST APT 6, DOWNSTAIRS UNDER THE PORCH, POCATELLO, ID 83201-5371
(218) 849-4128
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-5283
ID
Other
Enumeration date
06/28/2021
Last updated
06/28/2021
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