Individual provider Active NPI

Adrian E Pulkrabek, DDS

  • Dentist
  • Glendale, AZ
National Provider Identifier
1366587735
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4738 Issued in AZ
Practice address
18205 N 51St Ave
Suite 137
Glendale, AZ 85308
Phone
(602) 866-9825
Fax
(602) 866-2404
NPI assigned
Feb 21, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 4738 AZ Primary

Addresses

Primary practice location

18205 N 51St Ave
Suite 137
Glendale, AZ 85308

Mailing address

18205 N 51St Ave
Suite 137
Glendale, AZ 85308
Phone (602) 866-9825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180711003917 AZ Order and Referring Only - DentistPractitioner - Dentist 3971859521

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4738AZMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Adrian Pulkrabek DDS LLC Dentist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366587735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18205 N 51ST AVE",
            "address_2": "SUITE 137",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "602-866-9825",
            "fax_number": "602-866-2404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18205 N 51ST AVE",
            "address_2": "SUITE 137",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "602-866-9825",
            "fax_number": "602-866-2404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULKRABEK",
        "first_name": "ADRIAN",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "4738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.