Provider Demographics
NPI:1073736781
Name:PULLMAN, THOMAS MICHAEL (DR OF DENTAL SURGERY)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:PULLMAN
Suffix:
Gender:M
Credentials:DR OF DENTAL SURGERY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3910
Mailing Address - Country:US
Mailing Address - Phone:248-642-8130
Mailing Address - Fax:248-642-9314
Practice Address - Street 1:50 W BIG BEAVER RD
Practice Address - Street 2:SUITE 290
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3910
Practice Address - Country:US
Practice Address - Phone:248-642-8130
Practice Address - Fax:248-642-9314
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010133491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice