=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780043059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLE CULPEPPER DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2016
-----------------------------------------------------
Last Update Date | 08/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 55TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11220-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-579-2976
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2222 N AVENIDA MENA
-----------------------------------------------------
City | GREEN VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85614-3773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-579-2976
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223D0004X
-----------------------------------------------------
Taxonomy Name | Dental Anesthesiology
-----------------------------------------------------
License Number | D010249
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------