Provider Demographics
NPI:1235239419
Name:KUHLBERG, ANDREW J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:KUHLBERG
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 1:12 CHRISTMAS TREE HL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2125
Mailing Address - Country:US
Mailing Address - Phone:860-693-8072
Mailing Address - Fax:
Practice Address - Street 1:70 W AVON RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3517
Practice Address - Country:US
Practice Address - Phone:860-673-5081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0078241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics