Provider Demographics
NPI:1659829810
Name:PAUL G. CULVER DDS SC
Entity Type:Organization
Organization Name:PAUL G. CULVER DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:CULVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-782-1655
Mailing Address - Street 1:17160 W NORTH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4437
Mailing Address - Country:US
Mailing Address - Phone:262-782-1655
Mailing Address - Fax:262-796-2969
Practice Address - Street 1:17160 W NORTH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4437
Practice Address - Country:US
Practice Address - Phone:262-782-1655
Practice Address - Fax:262-796-2969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2961-15261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental