Provider Demographics
NPI:1285169623
Name:TED C. KAWULOK, D.D.S.
Entity type:Organization
Organization Name:TED C. KAWULOK, D.D.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAWULOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-442-8625
Mailing Address - Street 1:1400 28TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1096
Mailing Address - Country:US
Mailing Address - Phone:303-442-8625
Mailing Address - Fax:303-541-9867
Practice Address - Street 1:1400 28TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1096
Practice Address - Country:US
Practice Address - Phone:303-442-8625
Practice Address - Fax:303-541-9867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty