Provider Demographics
NPI:1164910006
Name:KULIG, LISA DIANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DIANE
Last Name:KULIG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 ELK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-1200
Mailing Address - Country:US
Mailing Address - Phone:701-839-4440
Mailing Address - Fax:701-839-1911
Practice Address - Street 1:2615 ELK DR STE 1
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-1200
Practice Address - Country:US
Practice Address - Phone:701-839-4440
Practice Address - Fax:701-839-1911
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND24151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDPENDINGMedicaid