Provider Demographics
NPI:1548610298
Name:MCCULLOUGH, CAYLIN NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:CAYLIN
Middle Name:NICOLE
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 LINGER LONGER DR UNIT 3309
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-3199
Mailing Address - Country:US
Mailing Address - Phone:816-273-6064
Mailing Address - Fax:
Practice Address - Street 1:6877 DORCHESTER RD STE 11
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-3700
Practice Address - Country:US
Practice Address - Phone:843-212-4693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.104761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics