Provider Demographics
NPI:1154466167
Name:KULLMAN, PAUL JOSEPH
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:KULLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 SIMONDS HILL ROAD
Mailing Address - Street 2:POST OFFICE BOX 29
Mailing Address - City:NEW RUSSIA
Mailing Address - State:NY
Mailing Address - Zip Code:12964
Mailing Address - Country:US
Mailing Address - Phone:518-873-6430
Mailing Address - Fax:
Practice Address - Street 1:134 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1251
Practice Address - Country:US
Practice Address - Phone:518-481-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDT000023481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice