Provider Demographics
NPI:1255485447
Name:CULBREATH, CHRISTIAN L (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:L
Last Name:CULBREATH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MURRAY GUARD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3609
Mailing Address - Country:US
Mailing Address - Phone:731-664-9900
Mailing Address - Fax:
Practice Address - Street 1:166 MURRAY GUARD DR
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3609
Practice Address - Country:US
Practice Address - Phone:731-664-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0052751223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
884473OtherUNITED CONCORDIA
TN0192497OtherBLUE CROSS & BLUE SHIELD