Jeannine Cullum, DDS
Individual provider Active NPI General Practice Dentistry · San Augustine, TX
NPI 1407036072 · NPPES record last updated Nov 12, 2007
Key facts
- NPI
- 1407036072
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 18319 (TX)
- Practice address
- 214 E Main St
San Augustine, TX 75972-2032 - Phone
- (936) 275-3101
- Fax
- (936) 275-1551
- NPI assigned
- Nov 12, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18319 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeannine Cullum DDS, PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 18319 | TX | Yes |
Addresses
Primary practice location
214 E Main St
San Augustine, TX 75972-2032
Mailing address
214 E Main St
San Augustine, TX 75972-2032
Phone (936) 275-3101
Other names
- Jeannine Cullum
Other providers in San Augustine, TX
- Deganda Brown
- Pamela Marie Bryant
- Erica Dominique Clack
- Maegan Lynn Coats
- Barbara Lynn Cole
- D & H Enterprises
- Economy Professional Pharmacy Inc
- Stacie L Edwards
- Valarie Edwards
- Enrique a Leal MD
All providers in San Augustine, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.