Healthcare Provider Details

I. General information

NPI: 1477840205
Provider Name (Legal Business Name): CYNTHIA ELAINE ULRICH D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNDI ULRICH D.D.S.

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 W OUTER 21 RD
ARNOLD MO
63010-3239
US

IV. Provider business mailing address

1333 W OUTER 21 RD
ARNOLD MO
63010-3239
US

V. Phone/Fax

Practice location:
  • Phone: 636-333-3304
  • Fax: 636-333-3307
Mailing address:
  • Phone: 636-333-3304
  • Fax: 636-333-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2011015405
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: