Provider Demographics
NPI:1003038571
Name:KULIKOWSKI, BOGDAN MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:BOGDAN
Middle Name:MICHAEL
Last Name:KULIKOWSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15215 S 48TH STREET
Mailing Address - Street 2:SUITE #158
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-9139
Mailing Address - Country:US
Mailing Address - Phone:480-598-3006
Mailing Address - Fax:480-598-1184
Practice Address - Street 1:15215 S 48TH STREET
Practice Address - Street 2:SUITE #158
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9139
Practice Address - Country:US
Practice Address - Phone:480-598-3006
Practice Address - Fax:480-598-1184
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZD61361223S0112X
IDD 3765 OS1223S0112X
WADE000068021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery