Provider Demographics
NPI:1144223694
Name:KULP, ALAN K (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:K
Last Name:KULP
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 1:3028 E NORTHRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-1631
Mailing Address - Country:US
Mailing Address - Phone:480-924-3062
Mailing Address - Fax:480-964-7334
Practice Address - Street 1:560 N STAPLEY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-7320
Practice Address - Country:US
Practice Address - Phone:480-964-2131
Practice Address - Fax:480-964-7334
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice