Dr. Daniel R Cullum PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D-3149-OS Issued in ID

Legal business name

DR. DANIEL R CULLUM PA

Practice address

1859 N Lakewood Dr
Ste 101
Coeur D Alene, ID 83814-2661

Phone

(208) 667-5565

Fax

(208) 765-9633

NPI assigned

Aug 10, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Daniel Cullum, DDS

Title

President

Phone

(208) 667-5565

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Implants Northwest Doing business as

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

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439164800000",
    "number": "1386020550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1859 N LAKEWOOD DR",
            "address_2": "STE 101",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142661",
            "telephone_number": "208-667-5565",
            "fax_number": "208-765-9633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1859 N LAKEWOOD DR",
            "address_2": "STE 101",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142661",
            "telephone_number": "208-667-5565",
            "fax_number": "208-765-9633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. DANIEL R CULLUM PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-10",
        "last_updated": "2015-08-10",
        "status": "A",
        "authorized_official_last_name": "CULLUM",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-667-5565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D-3149-OS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "D-3149-OS",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Implants Northwest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Oral and Maxillofacial Surgery (Dentist) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.