Provider Demographics
NPI:1700318003
Name:PETER S. KULKA DDS PC
Entity Type:Organization
Organization Name:PETER S. KULKA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KULKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-878-5522
Mailing Address - Street 1:105 WEBSTER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1227
Mailing Address - Country:US
Mailing Address - Phone:781-878-5522
Mailing Address - Fax:781-878-2903
Practice Address - Street 1:105 WEBSTER ST STE 3
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1227
Practice Address - Country:US
Practice Address - Phone:781-878-5522
Practice Address - Fax:781-878-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN15204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========Medicaid