DR. ROBERT LYLE MCCULLOUGH (NPI# 1164926788) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164926788 |
| Entity Type | Individual |
| Full Name | DR. ROBERT LYLE MCCULLOUGH |
| Credential | DMD |
| Practice Address |
11820 Sw King James Pl Ste 20 Tigard OR 97224-2481 |
| Mailing Address |
27440 Sw Vanderschuere Rd Hillsboro OR 97123-9439 |
| Practice Telephone | 5039682901 |
| Practice Fax Number | 5034064988 |
| Mailing Telephone | 5039648909 |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2019-09-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D11114 | OR | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790958304 | Robert Mccullough | Social Worker | 209 Black Oak Dr, Saint Peters, MO 63376-1740 | 2008-04-04 |
| 1235214503 | Robert W. Mccullough | Optometrist | 137 W Mill St, Jonesboro, GA 30236-3572 | 2006-10-26 |
| 1659331486 | Robert Dale Mccullough II | Internal Medicine | 5803 E 75th Pl, Tulsa, OK 74136-7255 | 2006-03-24 |
| 1386006922 | Robert E Mccullough II | Counselor | 1905 Continental Pl, Mount Vernon, WA 98273-5633 | 2016-03-23 |
| 1972892453 | Robert Michael Mccullough | Emergency Medicine | 2301 Holmes St, Tmc-hospital Hill, Kansas City, MO 64108-2640 | 2011-04-05 |
| 1740490739 | Robert Mccullough | Pharmacist | 1173 W Main St, Whitewater, WI 53190-1672 | 2007-05-22 |
| Street Address |
11820 SW KING JAMES PL STE 20 |
| City | TIGARD |
| State | OR |
| Zip Code | 97224-2481 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205135118 | Tigard Family Dental, PC | Dentist | 11820 Sw King James Pl Ste 20, Tigard, OR 97224-2481 | 2011-03-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154973139 | Katherine Raineri | Psychologist | 7213 Sw Hazel Fern Rd, Tigard, OR 97224 | 2019-07-10 |
| 1871064618 | Stacey A Wenzel | Speech-Language Pathologist | 17020 Sw Upper Boones Ferry Rd.,suite 201, Tigard, OR 97224 | 2018-12-05 |
| 1376010090 | Meredith Rae Brezinski | Physical Therapist | 18019 Sw Boones Ferry Road, Tigard, OR 97224 | 2018-10-31 |
| 1649759358 | Viktoriya A Chiliy | Behavior Technician | 15290 Sw Royalty Parkway, Tigard, OR 97224 | 2018-08-13 |
| 1609384866 | Rachel E King | Physical Therapist | 18040 Sw Lower Boones Ferry Rd Ste 200, Tigard, OR 97224 | 2018-01-22 |
| 1689190134 | Isabelle Cooper Klee Caballero | Speech-Language Pathologist | 17020 Sw Upper Boones Ferry Road Suite 201, Tigard, OR 97224 | 2017-08-16 |
| 1427573146 | Breanna M Sandefur | Behavior Technician | 15290 Sw Royalty Pkwy, Tigard, OR 97224 | 2017-08-03 |
| 1083141196 | Krista Espenship | Registered Nurse | 8032 Sw Ashford St, Tigard, OR 97224 | 2017-05-19 |
| 1275067928 | Emily Elizabeth Myers | Behavioral Analyst | 15290 Royalty Parkway, Tigard, OR 97224 | 2017-04-19 |
| 1235684937 | Melanie Salvador | Nurse Practitioner | 15352 Sw Oakmont Pl, Tigard, OR 97224 | 2016-08-23 |
| Find all providers in zip 97224 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730661794 | Jesse Thomas Achatz | Dentist | 7275 Sw Dartmouth St Ste 180, Tigard, OR 97223-8292 | 2018-09-05 |
| 1295188027 | Thanh-truc Nguyen | Dentist | 9735 Sw Shady Ln Ste 307, Tigard, OR 97223-5481 | 2016-07-17 |
| 1851772180 | Samuel David Seo | Dentist | 10115 Sw Nimbus Ave Ste 350, Tigard, OR 97223-4330 | 2015-06-11 |
| 1548600695 | Phil Han | Dentist | 11820 Sw King James Place Suite 20, Tigard, OR 97224 | 2013-07-02 |
| 1205135118 | Tigard Family Dental, PC | Dentist | 11820 Sw King James Pl Ste 20, Tigard, OR 97224-2481 | 2011-03-17 |
| 1902136989 | Adam Polan | Dentist | 7275 Sw Dartmouth St, Suite 180, Tigard, OR 97223-8623 | 2010-01-13 |
| 1437486800 | Kelly J Johnson | Dentist | 7420 Sw Bridgeport Rd, Suite 104, Tigard, OR 97224-7790 | 2009-11-05 |
| 1750515888 | Timothy J Houlihan Jr. | Dentist | 15495 Sw Sequoia Pkwy Ste 120, Tigard, OR 97224 | 2009-05-04 |
| 1942465398 | Scott B Bodyfelt | Dentist | 11765 Sw Greenburg Road, Tigard, OR 97223 | 2008-07-25 |
| 1780851105 | Bruno Da Costa Ddd,ms,pc | Dentist | 11995 Sw Pacific Hwy, Tigard, OR 97223-6474 | 2008-05-14 |
| Find all providers in TIGARD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.