Provider Demographics
NPI:1669850608
Name:TED C. KAWULOK D.D.S., P.C.
Entity Type:Organization
Organization Name:TED C. KAWULOK D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAWULOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-442-8625
Mailing Address - Street 1:1400 28TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1096
Mailing Address - Country:US
Mailing Address - Phone:303-442-8625
Mailing Address - Fax:303-541-9867
Practice Address - Street 1:1400 28TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1096
Practice Address - Country:US
Practice Address - Phone:303-442-8625
Practice Address - Fax:303-541-9867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty