Carly McCullough, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

057908 Issued in NY

Practice address

36 Homer Ave
Queensbury, NY 12804-2009

Phone

(518) 793-1345

NPI assigned

Jul 7, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cottrell and McCullough Dental PLLC

  • Dentist
  • Queensbury, NY
  • NPI 1891357067
  NPD (past) Authorized official

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445990400000",
    "number": "1154737526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 HOMER AVE",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128042009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 HOMER AVE",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128042009",
            "telephone_number": "518-793-1345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "CARLY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-07",
        "last_updated": "2015-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "057908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jody Martino, MS, CCC-SLP
• Martins Foods of South Burlington LLC
• Jenna N Matthews
• Christine M. Mattia, MS,CCC/SLP
• Linda P McCarthy, MA.CCC/SLP
• Sara Katherine McDonald, OTD, OTR/L
• Mary McGovern, M.S.ED., CF-SLP
• Molly McGrath, CASAC-T
• Elizabeth McIntyre, MS CCC-SLP
• Stephanie M McLain, FNP

• Dentist in Queensbury, NY
• Providers in Queensbury, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; 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.