Provider Demographics
NPI:1013077494
Name:KULBERSH, RICHARD (DMD,MS,PLC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:KULBERSH
Suffix:
Gender:M
Credentials:DMD,MS,PLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 METROPOLITAN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4102
Mailing Address - Country:US
Mailing Address - Phone:586-268-2700
Mailing Address - Fax:586-268-8961
Practice Address - Street 1:5555 METROPOLITAN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4102
Practice Address - Country:US
Practice Address - Phone:586-268-2700
Practice Address - Fax:586-268-8961
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI109781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics