Organization
DONERLSON-MCCULLOUGH DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARRYAL DONERLSON MCCULLOUGH DDS (OWNER)
(770) 961-1222
Entity
Organization
Contact information
Practice address
2339 LAKE HARBIN RD, MORROW, GA 30260
(770) 961-1222
Mailing address
2339 LAKE HARBIN RD, MORROW, GA 30260
(770) 961-1222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10775
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1312005
UNITED CONCORDIA
GA
01
—
167133
DORAL DENTAL
GA
01
—
39154
AVESIS
GA
Enumeration date
10/03/2006
Last updated
08/22/2020
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