Provider Demographics
NPI:1548714868
Name:KULA, THEODORE JOHN III (DDS MSD)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:JOHN
Last Name:KULA
Suffix:III
Gender:M
Credentials:DDS MSD
Other - Prefix:MR
Other - First Name:TADZIU
Other - Middle Name:JOHN
Other - Last Name:KULA
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:DDS MSD
Mailing Address - Street 1:800 POPLAR ST
Mailing Address - Street 2:DENTISTRY JUST FOR KIDS AND ORTHODONICS
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807
Mailing Address - Country:US
Mailing Address - Phone:812-234-7322
Mailing Address - Fax:812-234-2065
Practice Address - Street 1:800 POPLAR ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807
Practice Address - Country:US
Practice Address - Phone:812-234-7322
Practice Address - Fax:812-234-2065
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012170A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry