Provider Demographics
NPI:1356365159
Name:CULBREATH, GEORGE L SR (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:CULBREATH
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S COLLEGE ST
Mailing Address - Street 2:P.O. BOX 86
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-1868
Mailing Address - Country:US
Mailing Address - Phone:731-855-9282
Mailing Address - Fax:
Practice Address - Street 1:204 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-1868
Practice Address - Country:US
Practice Address - Phone:731-855-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS12131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice