Provider Demographics
NPI:1023467289
Name:ULLSTAD, CLAUS JOHAN (DDS, MS, MMS)
Entity type:Individual
Prefix:DR
First Name:CLAUS
Middle Name:JOHAN
Last Name:ULLSTAD
Suffix:
Gender:M
Credentials:DDS, MS, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NMRTCC SAN ANTONIO/SAMMC LNO
Mailing Address - Street 2:3851 ROGER BROOKE DRIVE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-808-2434
Mailing Address - Fax:
Practice Address - Street 1:BUDGE DENTAL CLINIC
Practice Address - Street 2:3145 GARDEN AVE #1278
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-808-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014163941223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics