Provider Demographics
NPI:1790744779
Name:CULLER, JOHN J III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:CULLER
Suffix:III
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 1:540 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508
Mailing Address - Country:US
Mailing Address - Phone:859-253-2285
Mailing Address - Fax:859-253-2286
Practice Address - Street 1:540 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508
Practice Address - Country:US
Practice Address - Phone:859-253-2285
Practice Address - Fax:859-253-2286
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000154482OtherANTHEM BCBS FED GOV
641639OtherUNITED CONCORDIA