Provider Demographics
NPI:1720047160
Name:KULICK, BETH MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:MICHELLE
Last Name:KULICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6021
Mailing Address - Country:US
Mailing Address - Phone:212-725-7017
Mailing Address - Fax:212-213-1170
Practice Address - Street 1:471 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6021
Practice Address - Country:US
Practice Address - Phone:212-725-7017
Practice Address - Fax:212-213-1170
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0512521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02637387Medicaid