Provider Demographics
NPI:1841392198
Name:CULBERSON, MYRON DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:DALE
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:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:LA
Mailing Address - Zip Code:70441-0536
Mailing Address - Country:US
Mailing Address - Phone:225-222-6156
Mailing Address - Fax:225-222-6015
Practice Address - Street 1:NORTH FIRST AND LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:LA
Practice Address - Zip Code:70441
Practice Address - Country:US
Practice Address - Phone:225-222-6156
Practice Address - Fax:225-222-6015
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1828068Medicaid