Provider Demographics
NPI:1154584522
Name:HULL, MICHAEL A (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:HULL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 JOHN COX RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 HUDSON DR
Practice Address - Street 2:SUITE 9B
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2801
Practice Address - Country:US
Practice Address - Phone:423-543-5263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412203122300000X
TNDS0000009381122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDS0000009381OtherTENNESSEE LICENSE NUMBER
VA0401412203OtherVIRGINIA LICENSE NUMBER