Jeffrey J McCullough, DMD, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

62289 Issued in CA

Practice address

4281 Katella Ave Ste 112
Los Alamitos, CA 90720

Phone

(714) 484-8700

NPI assigned

Feb 13, 2014

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 CA

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

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jeffrey J. McCullough DMD, Ms, Inc.

  • Periodontics
  • Los Alamitos, CA
  • NPI 1730672296
  NPD Authorized official

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

{
    "created_epoch": "1392249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528588800000",
    "number": "1497179253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4281 KATELLA AVE STE 112",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203502",
            "telephone_number": "714-484-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4281 KATELLA AVE STE 112",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "90720",
            "telephone_number": "714-484-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "JEFFREY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-02-13",
        "last_updated": "2018-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "62289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haniffa M Maznavi, M.D.
• Khalid Maznavi
• Marie Mbouni-Essomba, MD
• Felicia Spring McAdams
• Valerie McCorkle, PPS
• Maureen Elna McCullough, R.N .
• Adriana McCutcheon, PA-C
• Jennifer Lee McDaniel
• Erin Nicole McGinnis, PT, DPT
• Diana Marie McHugh

• Periodontics in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2018; 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.