MEDICARE: CULP DENTAL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1063097624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CULP DENTAL PA

Provider Business Mailing Address
First Line	:	1334 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2337
Country	:	US
Telephone Number	:	803-324-2921
Fax Number	:

Provider Business Practice Location Address
First Line	:	1334 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2337
Country	:	US
Telephone Number	:	803-324-2921
Fax Number	:	803-324-2491

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. CHARLES WILLIAM CULP
Credential	:	DMD
Telephone Number	:	803-324-2921

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	06/22/2021

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