1548714868 NPI number — MR. THEODORE JOHN KULA III DDS MSD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548714868 NPI number — MR. THEODORE JOHN KULA III DDS MSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KULA
Provider First Name:
THEODORE
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
DDS MSD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KULA
Provider Other First Name:
TADZIU
Provider Other Middle Name:
JOHN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
DDS MSD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548714868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 POPLAR ST
Provider Second Line Business Mailing Address:
DENTISTRY JUST FOR KIDS AND ORTHODONICS
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-234-7322
Provider Business Mailing Address Fax Number:
812-234-2065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 POPLAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-234-7322
Provider Business Practice Location Address Fax Number:
812-234-2065
Provider Enumeration Date:
08/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  12012170A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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