Provider Demographics
NPI:1154717049
Name:CULBREATH, TADASHA EARSELL (DMD)
Entity type:Individual
Prefix:
First Name:TADASHA
Middle Name:EARSELL
Last Name:CULBREATH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1300
Mailing Address - Country:US
Mailing Address - Phone:703-535-5568
Mailing Address - Fax:703-535-1583
Practice Address - Street 1:4480 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1300
Practice Address - Country:US
Practice Address - Phone:703-535-5568
Practice Address - Fax:703-535-1583
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014147241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice