Provider Demographics
NPI:1972045417
Name:JOHN E. CULP, III DMD, PC
Entity Type:Organization
Organization Name:JOHN E. CULP, III DMD, PC
Other - Org Name:JUNGLE ROOTS CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADOCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-759-1119
Mailing Address - Street 1:4232 E CHANDLER BLVD
Mailing Address - Street 2:SUITE #10
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8879
Mailing Address - Country:US
Mailing Address - Phone:480-759-1119
Mailing Address - Fax:480-759-1180
Practice Address - Street 1:4232 E CHANDLER BLVD
Practice Address - Street 2:SUITE #10
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8879
Practice Address - Country:US
Practice Address - Phone:480-759-1119
Practice Address - Fax:480-759-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty