1669550042 NPI number — PULLEN, DMD, P.C.

Table of content: (NPI 1669550042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669550042 NPI number — PULLEN, DMD, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULLEN, DMD, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669550042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2353 WHITESBURG DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-533-3735
Provider Business Mailing Address Fax Number:
256-533-3780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2353 WHITESBURG DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-533-3735
Provider Business Practice Location Address Fax Number:
256-533-3780
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
LUCY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
256-533-3735

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4401 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D100004 . This is a "CIGNA DMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 581423 . This is a "COMP BENEFITS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51092343 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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