Provider Demographics
NPI:1174728422
Name:CARY W. ULBRICH, DDS, LLC
Entity type:Organization
Organization Name:CARY W. ULBRICH, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ULBRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-257-5155
Mailing Address - Street 1:308 NOONAN DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-1118
Mailing Address - Country:US
Mailing Address - Phone:636-257-5155
Mailing Address - Fax:636-257-5255
Practice Address - Street 1:308 NOONAN DR
Practice Address - Street 2:SUITE E
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-1118
Practice Address - Country:US
Practice Address - Phone:636-257-5155
Practice Address - Fax:636-257-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0151741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty