Provider Demographics
NPI:1306057526
Name:CULLEN, VINCENT PAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PAUL
Last Name:CULLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 RED BARN LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2210
Mailing Address - Country:US
Mailing Address - Phone:215-947-0457
Mailing Address - Fax:
Practice Address - Street 1:4829 E STREET RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6647
Practice Address - Country:US
Practice Address - Phone:215-364-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018685L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics