Provider Demographics
NPI:1114377751
Name:CULLER, CHARLES W (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:CULLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18610 E RITTENHOUSE RD STE A103
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4504
Mailing Address - Country:US
Mailing Address - Phone:480-807-4000
Mailing Address - Fax:480-807-4002
Practice Address - Street 1:18610 E RITTENHOUSE RD STE A103
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4504
Practice Address - Country:US
Practice Address - Phone:480-807-4000
Practice Address - Fax:480-807-4002
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist