DRS. McCullom P.C.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

DRS. MCCULLOM P.C.

Practice address

820 E 87TH St
Suite 201
Chicago, IL 60619-6253

Phone

(773) 488-3738

Fax

(773) 874-6575

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Yetta G McCullom, DDS

Title

VP and Cheif Finanical Officer

Phone

(773) 488-3738

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1972649200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E 87TH ST",
            "address_2": "SUITE 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606196253",
            "telephone_number": "773-488-3738",
            "fax_number": "773-874-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E 87TH ST",
            "address_2": "SUITE 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606196253",
            "telephone_number": "773-488-3738",
            "fax_number": "773-874-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS. MCCULLOM P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MCCULLOM",
        "authorized_official_first_name": "YETTA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "VP AND CHEIF FINANICAL OFFICER",
        "authorized_official_telephone_number": "773-488-3738",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.