Provider Demographics
NPI:1134980261
Name:KULICK, CYNTHIA LAURIE (DMD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LAURIE
Last Name:KULICK
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 1:425 MADISON AVE RM 201
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1120
Mailing Address - Country:US
Mailing Address - Phone:212-750-2626
Mailing Address - Fax:
Practice Address - Street 1:425 MADISON AVE RM 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1120
Practice Address - Country:US
Practice Address - Phone:212-750-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0365181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice