Provider Demographics
NPI:1437268463
Name:KULISEK, KATHLEEN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:L
Last Name:KULISEK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 PEACH STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501
Mailing Address - Country:US
Mailing Address - Phone:814-454-0001
Mailing Address - Fax:814-454-0025
Practice Address - Street 1:1611 PEACH STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501
Practice Address - Country:US
Practice Address - Phone:814-454-0001
Practice Address - Fax:814-454-0025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024652L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist