Individual provider · Type 1 NPI
Cornell McCullom Iii, DDS, MD
Oral and Maxillofacial Surgery (Dentist) · Chicago, IL
NPI number
1619124807
Active
Practice location
820 E 87th St, Ste. 201
Chicago, IL 60619-6253
Fax (773) 874-6575
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) Primary | 1223S0112X | 021001488 (IL) |
Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
4 other providers at this address
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About NPI 1619124807
Cornell McCullom Iii, DDS, MD's National Provider Identifier is 1619124807, issued on Aug 19, 2008. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Chicago, IL. The record was last updated on Aug 19, 2008.