Provider Demographics
NPI:1356428031
Name:KULIK, TIMOTHY S (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:S
Last Name:KULIK
Suffix:
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 1:211 N SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2823
Mailing Address - Country:US
Mailing Address - Phone:574-288-1900
Mailing Address - Fax:574-288-3900
Practice Address - Street 1:211 N SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2823
Practice Address - Country:US
Practice Address - Phone:574-288-1900
Practice Address - Fax:574-288-3900
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist