Provider Demographics
NPI:1447460530
Name:KULKARNI, SHAMA ANIL (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAMA
Middle Name:ANIL
Last Name:KULKARNI
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 1:761 TEABERRY LN
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3183
Mailing Address - Country:US
Mailing Address - Phone:814-238-2929
Mailing Address - Fax:
Practice Address - Street 1:407 E CALDER WAY
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5663
Practice Address - Country:US
Practice Address - Phone:814-234-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029145L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice