Provider Demographics
NPI:1609161652
Name:KULYK DENTAL CORPORATION
Entity Type:Organization
Organization Name:KULYK DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KULYK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-457-1810
Mailing Address - Street 1:1450 CREEKSIDE DR APT 61
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5535
Mailing Address - Country:US
Mailing Address - Phone:925-935-1898
Mailing Address - Fax:
Practice Address - Street 1:1744 NOVATO BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3092
Practice Address - Country:US
Practice Address - Phone:925-457-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty