Willie Mclullum Dds - Children'S Dentistry
LBN: Wjm Dental Inc
Willie Mclullum Dds - Children'S Dentistry is an health care organization with primary practice located at 4002 South M Street Suite A, Tacoma WA 98418. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / General Practice is the primary health care specialty.
Wjm Dental Inc can be contacted via phone (253) 474-0606, or through Mccullum, Willie James via phone (253) 474-0606.
Contact Information
Primary practice address
4002 South M Street Suite A
Tacoma WA 98418
Phone: (253) 474-0606
Fax:
Website:
Authorized official contact:
Name: Mccullum, Willie James Doctor of Dental Surgery (DDS)
Phone: (253) 474-0606
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 6326 | Washington |
| Dental Providers / Pediatric Dentistry | 1223P0221X | 8920 | Washington |
Profile Details
| NPI number | 1407166655 |
|---|---|
| LBN Legal business name | Wjm Dental Inc |
| DBA Doing business as | Willie Mclullum Dds - Children'S Dentistry |
| Authorized official | Mccullum, Willie James Doctor of Dental Surgery (DDS) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 20th, 2010 |
| Last updated | Dec 18th, 2012 - about 13 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1407166655 | NPPES |
| Washington | MEDICAID | 5050273 |
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