Provider Demographics
NPI:1043376320
Name:CULLEN, BRIAN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:CULLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2359 S 22ND DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8871
Mailing Address - Country:US
Mailing Address - Phone:928-329-9565
Mailing Address - Fax:928-783-0669
Practice Address - Street 1:2359 S 22ND DR
Practice Address - Street 2:SUITE 1
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8871
Practice Address - Country:US
Practice Address - Phone:928-329-9565
Practice Address - Fax:928-783-0669
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAZ41111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry