Provider Demographics
NPI:1366587735
Name:PULKRABEK, ADRIAN E (DDS)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:E
Last Name:PULKRABEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18205 N 51ST AVE
Mailing Address - Street 2:SUITE 137
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:602-866-9825
Mailing Address - Fax:602-866-2404
Practice Address - Street 1:18205 N 51ST AVE
Practice Address - Street 2:SUITE 137
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:602-866-9825
Practice Address - Fax:602-866-2404
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist