Provider Demographics
NPI:1942380555
Name:CULBERTSON, BONNIE LYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LYNNE
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 YORK ROAD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-823-8823
Mailing Address - Fax:410-823-6361
Practice Address - Street 1:1134 YORK ROAD
Practice Address - Street 2:SUITE 305
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-823-8823
Practice Address - Fax:410-823-6361
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice