Daniel Ray Cullum, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D3149-0S Issued in ID

Practice address

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

Phone

(208) 667-5565

Fax

(208) 765-9633

NPI assigned

Nov 8, 2006

Last updated

Jul 8, 2007By 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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 12, 2015 through Oct 12, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Dr. Daniel R Cullum PA

  dba Implants Northwest

  • Oral and Maxillofacial Surgery (Dentist)
  • Coeur d'Alene, ID
  • NPI 1386020550
  Authorized official Same address or phone

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689744831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1859 N LAKEWOOD DR",
            "address_2": "SUITE 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": "SUITE 101",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142661",
            "telephone_number": "208-667-5565",
            "fax_number": "208-765-9633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLUM",
        "first_name": "DANIEL",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D3149-0S",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Briana Crotinger, LMT
• Pamela Diane Crowe
• Charles Qiming Cui, M.D.
• Ginger Laraine Cullen, BSM, LM, CPM
• Robert Chase Cullen
• Cultivation, LLC (Cultivation Counseling)
• Cultivation, LLC
• Sharon Anne Cunningham, PTA
• Jack Curran, MD
• Phillip J Currie, PHARMD

• 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 Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.