Provider Demographics
NPI:1548511272
Name:MCCULLOCH, KARA J (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:J
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4812
Mailing Address - Country:US
Mailing Address - Phone:425-502-8936
Mailing Address - Fax:
Practice Address - Street 1:2817 80TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2913
Practice Address - Country:US
Practice Address - Phone:206-232-9600
Practice Address - Fax:206-232-2936
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA78441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics