Brian Todd McCullough

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4251-21 Issued in MS

Practice address

706 Belle Oak TRL
Brandon, MS 39042-8205

Phone

(166) 254-9795

NPI assigned

Oct 4, 2021

Last updated

Oct 4, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1417629817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 BELLE OAK TRL",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390428205",
            "telephone_number": "166-254-9795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 BELLE OAK TRL",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390428205",
            "telephone_number": "166-254-9795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "BRIAN",
        "middle_name": "TODD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-04",
        "certification_date": "2021-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "4251-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peighton Mays
• Hazel McCaughan, DMD
• Monica McClellan, MSW
• Kristi McCluskey, PHARMD
• Tamiko Thames McCollum, LMSW
• Carly B McDaniel, CRNA
• Darby Faith McDaniel
• Daniel McDonald, RN
• Rochelsey McDonald
• Ariel Rene McDowell

• General Practice Dentistry in Brandon, MS
• Providers in Brandon, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.