Provider Demographics
NPI:1528174703
Name:ULRICH, EDWARD PAUL JR (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PAUL
Last Name:ULRICH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13245 BOOKER T WASHINGTON HWY
Mailing Address - Street 2:STE D
Mailing Address - City:HARDY
Mailing Address - State:VA
Mailing Address - Zip Code:24101-3947
Mailing Address - Country:US
Mailing Address - Phone:540-721-2448
Mailing Address - Fax:540-721-3215
Practice Address - Street 1:13245 BOOKER T WASHINGTON HWY
Practice Address - Street 2:STE D
Practice Address - City:HARDY
Practice Address - State:VA
Practice Address - Zip Code:24101-3947
Practice Address - Country:US
Practice Address - Phone:540-721-2448
Practice Address - Fax:540-721-3215
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA054971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice