Provider Demographics
NPI:1669505418
Name:KULA, KATHERINE SUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SUE
Last Name:KULA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1121 W. MICHIGAN STREET
Mailing Address - Street 2:DS 307B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5186
Mailing Address - Country:US
Mailing Address - Phone:317-278-3632
Mailing Address - Fax:317-274-2603
Practice Address - Street 1:1121 W. MICHIGAN STREET
Practice Address - Street 2:DS 307B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5186
Practice Address - Country:US
Practice Address - Phone:317-278-3632
Practice Address - Fax:317-274-2603
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO0159661223X0400X
IN12011088A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics