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WJM DENTAL INC NPI 1407166655


NPI Information

NPI: 1407166655
Provider Name: WJM DENTAL INC

Other Name: WILLIE MCLULLUM DDS - CHILDREN'S DENTISTRY

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
4002 SOUTH M STREET
SUITE A
TACOMA, WA
ZIP 98418
Phone: (253) 474-0606
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WJM DENTAL INC is a general practice dentist in Tacoma, WA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. WJM DENTAL INC NPI is 1407166655. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Other Name Is Willie Mclullum Dds - Children's Dentistry.

The provider's business location address is:

4002 SOUTH M STREET
SUITE A
TACOMA, WA
ZIP 98418
Phone: (253) 474-0606

The provider's authorized official is Willie James Mccullum .
The authorized official title is Dentist/owner and has the following contact phone number (253) 474-0606.

The enumeration date for this NPI number is 10/20/2010 and was last updated on 12/18/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0221XDentistPediatric Dentistry8920WASHINGTONNo
21223G0001XDentistGeneral Practice6326WASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
15050273MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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