Organization Active NPI

McCullough and Stevens

  • General Practice Dentistry
  • Trussville, AL
National Provider Identifier
1104064559
Registry record updated Jan 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5210 Issued in AL
Legal business name
MCCULLOUGH AND STEVENS
Practice address
4643 Camp Coleman Rd Ste 125
Trussville, AL 35173-2838
Phone
(205) 218-9823
NPI assigned
Jan 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Christian Adama Stevens, DMD
Title
Partner Dentist
Phone
(205) 218-9823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5210 AL Primary

Addresses

Primary practice location

4643 Camp Coleman Rd Ste 125
Trussville, AL 35173-2838

Mailing address

4643 Camp Coleman Rd Ste 125
Trussville, AL 35173-2838
Phone (205) 218-9823

National Provider Directory

National Provider Directory

Locations

4643 Camp Coleman Rd
Ste 125
Trussville, AL 35173
Phone (205) 218-9823

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232582400000",
    "number": "1104064559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4643 CAMP COLEMAN RD STE 125",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351732838",
            "telephone_number": "205-218-9823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4643 CAMP COLEMAN RD STE 125",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351732838",
            "telephone_number": "205-218-9823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCULLOUGH AND STEVENS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-22",
        "last_updated": "2009-01-22",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "ADAMA",
        "authorized_official_title_or_position": "PARTNER DENTIST",
        "authorized_official_telephone_number": "205-218-9823",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "5210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trussville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.