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General NPI Number Information
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NPI Number | 1649963802
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Entity Type | Individual
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Provider Name | JOHN BRADY CULBERTSON DDS
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Gender | Male
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 427 STONE WOOD DR
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City | BROKEN ARROW
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State | OK
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Zip | 74012-1026
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Country | US
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Telephone | 918-615-3580
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Fax |
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Provider Business Mailing Address
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Address Line | 4051 S 211TH EAST AVE
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City | BROKEN ARROW
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State | OK
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Zip | 74014-8717
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Country | US
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Telephone | 469-261-5501
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7734
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License Number State | OK
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