Provider Demographics
NPI:1730244492
Name:MCCULLOUGH, STEPHEN K (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:K
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W VANDAMENT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4655
Mailing Address - Country:US
Mailing Address - Phone:405-350-1343
Mailing Address - Fax:
Practice Address - Street 1:508 W VANDAMENT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4655
Practice Address - Country:US
Practice Address - Phone:405-350-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics