Provider Demographics
NPI:1528392206
Name:KULYK, ANDRIY VASYLYOVYCH (DDS)
Entity Type:Individual
Prefix:
First Name:ANDRIY
Middle Name:VASYLYOVYCH
Last Name:KULYK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CREEKSIDE DR
Mailing Address - Street 2:APT 61
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5558
Mailing Address - Country:US
Mailing Address - Phone:925-457-1810
Mailing Address - Fax:
Practice Address - Street 1:1450 CREEKSIDE DR
Practice Address - Street 2:APT 61
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5558
Practice Address - Country:US
Practice Address - Phone:925-457-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist