Provider Demographics
NPI:1972512812
Name:KULL, ROBERT S (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:KULL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4134 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3044
Mailing Address - Country:US
Mailing Address - Phone:716-675-5858
Mailing Address - Fax:716-675-4872
Practice Address - Street 1:4134 SENECA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14224-3044
Practice Address - Country:US
Practice Address - Phone:716-675-5858
Practice Address - Fax:716-675-4872
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0285171223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4001292OtherINDEPENDENT HEALTH INS
NY161589601OtherTIN
NY161589601OtherTIN