NPIMap

Organization Active NPI

WJM Dental Inc

  • General Practice Dentistry
  • Tacoma, WA
National Provider Identifier
1407166655
Registry record updated Dec 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6326 Issued in WA
Legal business name
WJM DENTAL INC
Practice address
4002 South M Street
Suite a
Tacoma, WA 98418
Phone
(253) 474-0606
NPI assigned
Oct 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2012

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

Authorized official

Name
Dr. Willie James McCullum, D.D.S.NPI 1083622971
Title
Dentist/Owner
Phone
(253) 474-0606

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 6326 WA Primary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 8920 WA

Addresses

Primary practice location

4002 South M Street
Suite a
Tacoma, WA 98418

Mailing address

4002 South M Street
Suite a
Tacoma, WA 98418
Phone (253) 474-0606

Other identifiers 1

IdentifierTypeStateIssuer
5050273MedicaidWA

Other names 1

  • Willie McLullum DDS - Children's Dentistry Other name

National Provider Directory

National Provider Directory

Locations

4002 S M St
Ste A
Tacoma, WA 98418
Phone (253) 474-0606

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355788800000",
    "number": "1407166655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4002 SOUTH M STREET",
            "address_2": "SUITE A",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98418",
            "telephone_number": "253-474-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4002 SOUTH M STREET",
            "address_2": "SUITE A",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98418",
            "telephone_number": "253-474-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WJM DENTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-20",
        "last_updated": "2012-12-18",
        "status": "A",
        "authorized_official_last_name": "MCCULLUM",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "253-474-0606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "6326",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "8920",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5050273",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willie McLullum DDS - Children's Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; 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.