Provider Demographics
NPI:1679796056
Name:CULBERSON, CASON FREDERICK (DDS)
Entity Type:Individual
Prefix:
First Name:CASON
Middle Name:FREDERICK
Last Name:CULBERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16030 BOTHELL EVERETT HWY STE 280
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1599
Mailing Address - Country:US
Mailing Address - Phone:425-481-4974
Mailing Address - Fax:425-338-4930
Practice Address - Street 1:16030 BOTHELL EVERETT HWY STE 280
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1599
Practice Address - Country:US
Practice Address - Phone:425-481-4974
Practice Address - Fax:425-338-4930
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA91121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice