Provider Demographics
NPI:1568739332
Name:TIMOTHY S. KULIK D.D.S.,P.C.
Entity Type:Organization
Organization Name:TIMOTHY S. KULIK D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SIGMUND
Authorized Official - Last Name:KULIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-288-1900
Mailing Address - Street 1:211 N SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2823
Mailing Address - Country:US
Mailing Address - Phone:574-288-1900
Mailing Address - Fax:574-288-3900
Practice Address - Street 1:211 N SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2823
Practice Address - Country:US
Practice Address - Phone:574-288-1900
Practice Address - Fax:574-288-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty