Provider Demographics
NPI:1477840205
Name:ULRICH, CYNTHIA ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:ULRICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CYNDI
Other - Middle Name:
Other - Last Name:ULRICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1333 W OUTER 21 RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-3239
Mailing Address - Country:US
Mailing Address - Phone:636-333-3304
Mailing Address - Fax:636-333-3307
Practice Address - Street 1:1333 W OUTER 21 RD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-3239
Practice Address - Country:US
Practice Address - Phone:636-333-3304
Practice Address - Fax:636-333-3307
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011015405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist