Healthcare Provider Details

I. General information

NPI: 1497901219
Provider Name (Legal Business Name): CULLMAN ENDODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 AL HIGHWAY 157 STE A
CULLMAN AL
35058-0672
US

IV. Provider business mailing address

1965 AL HIGHWAY 157 STE A
CULLMAN AL
35058-0672
US

V. Phone/Fax

Practice location:
  • Phone: 256-737-9838
  • Fax: 256-737-9839
Mailing address:
  • Phone: 256-737-9838
  • Fax: 256-737-9839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5432
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1053574434
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerINDIVIDUAL NPI

VIII. Authorized Official

Name: DR. JOSHUA MICHAEL ROBINSON
Title or Position: OWNER/PRESIDENT
Credential: D.M.D.
Phone: 256-737-9838