1962830232 NPI number — DR. JOHN B MCCOLLUM D.D.S.

Table of content: GLAVIA SMITH MSW (NPI 1114323110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962830232 NPI number — DR. JOHN B MCCOLLUM D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOLLUM
Provider First Name:
JOHN
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962830232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1255
Provider Second Line Business Mailing Address:
110 S.
Provider Business Mailing Address City Name:
DILLON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-683-5125
Provider Business Mailing Address Fax Number:
406-683-5126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 S. IDAHO STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DILLON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-683-5125
Provider Business Practice Location Address Fax Number:
406-683-5126
Provider Enumeration Date:
10/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  1108 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0132587 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com