Provider Demographics
NPI:1114099140
Name:CHESTER B KULAK DMD PA
Entity Type:Organization
Organization Name:CHESTER B KULAK DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:B
Authorized Official - Last Name:KULAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-882-9443
Mailing Address - Street 1:2796 PRINCETON PIKE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3221
Mailing Address - Country:US
Mailing Address - Phone:609-882-9443
Mailing Address - Fax:
Practice Address - Street 1:2796 PRINCETON PIKE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3221
Practice Address - Country:US
Practice Address - Phone:609-882-9443
Practice Address - Fax:609-883-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ08115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty