Provider Demographics
NPI:1568479640
Name:CULVER, JIMMY LON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:LON
Last Name:CULVER
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 1:274 BARNSTABLE RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2919
Mailing Address - Country:US
Mailing Address - Phone:508-771-0500
Mailing Address - Fax:
Practice Address - Street 1:274 BARNSTABLE RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2919
Practice Address - Country:US
Practice Address - Phone:508-771-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00006851223S0112X
MADN130061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002340Medicaid
VTVT2340Medicare ID - Type Unspecified
VTU34741Medicare UPIN