Provider Demographics
NPI:1063036721
Name:CULBERTSON, CHASE RYAN (DDS)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:RYAN
Last Name:CULBERTSON
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 1:814 NEIL AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1330
Mailing Address - Country:US
Mailing Address - Phone:937-244-6471
Mailing Address - Fax:
Practice Address - Street 1:1109 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3025
Practice Address - Country:US
Practice Address - Phone:740-630-9380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0261541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice