Healthcare Provider Details

I. General information

NPI: 1295168094
Provider Name (Legal Business Name): EWELINA CIULA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 21ST STREET US ARMY DENTAL ACTIVITY
FORT CAMPBELL KY
42223
US

IV. Provider business mailing address

2441 21ST STREET US ARMY DENTAL ACTIVITY
FORT CAMPBELL KY
42223
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8614
  • Fax: 270-956-0266
Mailing address:
  • Phone: 270-798-8614
  • Fax: 270-956-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9372
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: