Provider Demographics
NPI:1679588263
Name:HULSE DENTAL PRACTICE PC
Entity type:Organization
Organization Name:HULSE DENTAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:ARBREY
Authorized Official - Last Name:HULSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-640-5565
Mailing Address - Street 1:7424 S. NORTHSHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:865-804-2465
Mailing Address - Fax:865-671-3067
Practice Address - Street 1:7424 S. NORTHSHORE DRIVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-804-2465
Practice Address - Fax:865-671-3067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty