Matthew J McCullough DMD PC

Primary specialty

DentistTaxonomy code 122300000X

License

019025298 Issued in IL

Legal business name

MATTHEW J MCCULLOUGH DMD PC

Practice address

1300 E City Route 40
Greenville, IL 62246-2501

Phone

(618) 664-1483

NPI assigned

Feb 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Matthew James McCullough, D.M.D.

Title

President

Phone

(618) 664-1483

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kalei Nguyen Wilson, DDS

  • Dentist
  • Greenville, IL
  • NPI 1396482733
  NPD (past)

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430956800000",
    "number": "1245379171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 E CITY ROUTE 40",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622462501",
            "telephone_number": "618-664-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E CITY ROUTE 40",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622462501",
            "telephone_number": "618-664-1483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW J MCCULLOUGH DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2015-05-07",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-664-1483",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019025298",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "IL",
            "license": "019-025298",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Nicole Mabry, LMT
• Kathryn K Macdonald, M.D.
• Andrew Mahtani, M.D.
• Marion Eye Centers LTD.
• Mary Elizabeth Massena, LCSW
• Krystal Marie McClenahan, MPT
• Boyd A. McCracken, M.D.
• Matthew James McCullough, D.M.D.
• Brittany Morgan McKinzie, BA
• Timothy McNeill, LPC

• Dentist in Greenville, IL
• Providers in Greenville, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.