Provider Demographics
NPI:1033108493
Name:KULICK, VICTOR B (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:B
Last Name:KULICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14601 PURITAS AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-2815
Mailing Address - Country:US
Mailing Address - Phone:216-671-5452
Mailing Address - Fax:
Practice Address - Street 1:14601 PURITAS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-2815
Practice Address - Country:US
Practice Address - Phone:216-671-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist