Active NPI
Lisa Diane Kulig, DDS
- Pediatric Dentistry
- Minot, ND
National Provider Identifier
1164910006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 2415
- Practice address
- 2615 Elk Dr Ste 1
Minot, ND 58701-1200 - Phone
- (701) 839-4440
- Fax
- (701) 839-1911
- NPI assigned
- Apr 26, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 2415 | ND | Primary |
Addresses
Primary practice location
2615 Elk Dr Ste 1
Minot, ND 58701-1200
Mailing address
2615 Elk Dr Ste 1
Minot, ND 58701-1200
Phone (701) 839-4440
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2415 | ND | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597708800000",
"number": "1164910006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2615 ELK DR STE 1",
"city": "MINOT",
"state": "ND",
"postal_code": "587011200",
"telephone_number": "701-839-4440",
"fax_number": "701-839-1911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2615 ELK DR STE 1",
"city": "MINOT",
"state": "ND",
"postal_code": "587011200",
"telephone_number": "701-839-4440",
"fax_number": "701-839-1911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KULIG",
"first_name": "LISA",
"middle_name": "DIANE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-26",
"last_updated": "2020-08-18",
"certification_date": "2020-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "ND",
"license": "2415",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minot, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.