Provider Demographics
NPI:1154542090
Name:PULLARA, PETER J JR (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:PULLARA
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 1:15412 S ROUTE 59
Mailing Address - Street 2:UNIT #7
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-1979
Mailing Address - Country:US
Mailing Address - Phone:815-436-1000
Mailing Address - Fax:815-436-1464
Practice Address - Street 1:5080 E BAY VIEW DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-9785
Practice Address - Country:US
Practice Address - Phone:815-735-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist