Provider Demographics
NPI:1871097105
Name:CULLEY, MAKAYLA MARIE (RDH EPP)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:MARIE
Last Name:CULLEY
Suffix:
Gender:F
Credentials:RDH EPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845-1037
Mailing Address - Country:US
Mailing Address - Phone:541-628-6206
Mailing Address - Fax:541-516-4060
Practice Address - Street 1:750 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-1037
Practice Address - Country:US
Practice Address - Phone:541-628-6206
Practice Address - Fax:541-516-4060
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6230124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist