Provider Demographics
NPI:1356597918
Name:KULICK, MICHAEL ISIDORE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ISIDORE
Last Name:KULICK
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 1:1220 W PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6713
Mailing Address - Country:US
Mailing Address - Phone:440-888-8811
Mailing Address - Fax:
Practice Address - Street 1:1220 W PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-6713
Practice Address - Country:US
Practice Address - Phone:440-888-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30017370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist