Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | D 3765 OS | ID |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D6136 | AZ |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DE00006802 | WA |
NPI | 1003038571 |
---|---|
Provider Name | Dr. Bogdan Michael Kulikowski |
First Address | Phoenix, AZ 85044-9139 |
Second Address | Phoenix, AZ 85044-9139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |