Provider Demographics
NPI:1649963802
Name:CULBERTSON, JOHN BRADY (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRADY
Last Name:CULBERTSON
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 1:4051 S 211TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-8717
Mailing Address - Country:US
Mailing Address - Phone:469-261-5501
Mailing Address - Fax:
Practice Address - Street 1:427 STONE WOOD DR
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1026
Practice Address - Country:US
Practice Address - Phone:918-615-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7734122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist