Provider Demographics
NPI:1588016349
Name:KULKARNI, VISHAL
Entity Type:Individual
Prefix:
First Name:VISHAL
Middle Name:
Last Name:KULKARNI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 37TH ST APT 1836
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-4837
Mailing Address - Country:US
Mailing Address - Phone:484-860-5551
Mailing Address - Fax:
Practice Address - Street 1:1021 37TH ST APT 1836
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-4837
Practice Address - Country:US
Practice Address - Phone:484-860-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice