Provider Demographics
NPI:1750498911
Name:KULIG, GLEN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:J
Last Name:KULIG
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 1:500 W MAPLE
Mailing Address - Street 2:STE 202
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451
Mailing Address - Country:US
Mailing Address - Phone:815-485-8188
Mailing Address - Fax:815-485-8193
Practice Address - Street 1:500 W MAPLE
Practice Address - Street 2:STE 202
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451
Practice Address - Country:US
Practice Address - Phone:815-485-8188
Practice Address - Fax:815-485-8193
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19016319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist