Provider Demographics
NPI:1912687666
Name:WALTER K KULICK DMD PA
Entity Type:Organization
Organization Name:WALTER K KULICK DMD PA
Other - Org Name:DR WALTER KULICK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:KULICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-341-0500
Mailing Address - Street 1:8890 ROYAL PALM BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5803
Mailing Address - Country:US
Mailing Address - Phone:954-341-0500
Mailing Address - Fax:
Practice Address - Street 1:8890 ROYAL PALM BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5803
Practice Address - Country:US
Practice Address - Phone:954-341-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1366872467OtherDR. MUYEENUL HASSAN
FL1144384793OtherDR.SHAYAN GHODSI
FL1477953677OtherDR. VIBHOR IDNANI
FL1750995205OtherDR. DANIYEL IGLESIAS