Provider Demographics
NPI:1679625255
Name:CULLEN, BRIAN STUART (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:STUART
Last Name:CULLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-1845
Mailing Address - Country:US
Mailing Address - Phone:508-627-6464
Mailing Address - Fax:
Practice Address - Street 1:258 EDGARTOWN RD.
Practice Address - Street 2:UNIT 2
Practice Address - City:EDGARTOWN
Practice Address - State:MA
Practice Address - Zip Code:02539
Practice Address - Country:US
Practice Address - Phone:508-627-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA134401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice