Provider Demographics
NPI:1629123674
Name:THEODORE K. KULAGA, D.D.S., P. C.
Entity Type:Organization
Organization Name:THEODORE K. KULAGA, D.D.S., P. C.
Other - Org Name:LIVINGSTON DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KULAGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-222-6061
Mailing Address - Street 1:422 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3456
Mailing Address - Country:US
Mailing Address - Phone:406-222-6061
Mailing Address - Fax:406-222-6062
Practice Address - Street 1:422 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3456
Practice Address - Country:US
Practice Address - Phone:406-222-6061
Practice Address - Fax:406-222-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty