Provider Demographics
NPI:1073050423
Name:CULBERSON, ALEX M (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:M
Last Name:CULBERSON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 JAMESTOWN BLVD BLDG 100
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4131
Mailing Address - Country:US
Mailing Address - Phone:706-549-4748
Mailing Address - Fax:
Practice Address - Street 1:600 OGLETHORPE AVE STE 3
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2263
Practice Address - Country:US
Practice Address - Phone:706-319-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0152821223X0400X
OH37291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics