MEDICARE: DR. ANDREW THERON KULICK D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN17176	FL

General Provider Information

NPI Number	:	1740240266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW THERON KULICK D.M.D.

Provider Business Mailing Address
First Line	:	261 US HIGHWAY 27 N
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-2146
Country	:	US
Telephone Number	:	863-382-2816
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 US HIGHWAY 27 N
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-2146
Country	:	US
Telephone Number	:	863-382-2816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	12/27/2007

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