Provider Demographics
NPI:1982689998
Name:KULLAR, AMRIT P (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMRIT
Middle Name:P
Last Name:KULLAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 S PACIFICO ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-2072
Mailing Address - Country:US
Mailing Address - Phone:209-597-0381
Mailing Address - Fax:
Practice Address - Street 1:4598 S TRACY BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8107
Practice Address - Country:US
Practice Address - Phone:209-597-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist