Healthcare Provider Details

I. General information

NPI: 1437119153
Provider Name (Legal Business Name): JAMES LEE CULBERTSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 S 20TH AVE
SAFFORD AZ
85546-4009
US

IV. Provider business mailing address

1596 S CACTUS WREN LN
THATCHER AZ
85552-5392
US

V. Phone/Fax

Practice location:
  • Phone: 928-348-9181
  • Fax:
Mailing address:
  • Phone: 928-348-7946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4356
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: