Healthcare Provider Details

I. General information

NPI: 1740240266
Provider Name (Legal Business Name): ANDREW THERON KULICK D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 SE LAKE WEIR AVE
OCALA FL
34471-6724
US

IV. Provider business mailing address

2401 SE LAKE WEIR AVE
OCALA FL
34471-6724
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-3030
  • Fax:
Mailing address:
  • Phone: 352-732-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: