Provider Demographics
NPI:1588609432
Name:STULTS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:STULTS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELYNN
Authorized Official - Middle Name:W
Authorized Official - Last Name:STULTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-966-0218
Mailing Address - Street 1:1055 ENGEL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1239
Mailing Address - Country:US
Mailing Address - Phone:765-966-0218
Mailing Address - Fax:765-935-5307
Practice Address - Street 1:1055 ENGEL DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1239
Practice Address - Country:US
Practice Address - Phone:765-966-0218
Practice Address - Fax:765-935-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty