Healthcare Provider Details

I. General information

NPI: 1780043059
Provider Name (Legal Business Name): DANIELLE CULPEPPER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST
BROOKLYN NY
11220-2508
US

IV. Provider business mailing address

2222 N AVENIDA MENA
GREEN VALLEY AZ
85614-3773
US

V. Phone/Fax

Practice location:
  • Phone: 520-579-2976
  • Fax:
Mailing address:
  • Phone: 520-579-2976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberD010249
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: