Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | AZ4111 | AZ |
NPI | 1043376320 |
---|---|
Provider Name | Dr. Brian L. Cullen |
First Address | Yuma, AZ 85364-8871 |
Second Address | Yuma, AZ 85364-8871 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/07/2007 |