Provider Demographics
NPI:1215128129
Name:PULLER, ANTHONY JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
Last Name:PULLER
Suffix:
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 1:7834 FOREST HILL AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1974
Mailing Address - Country:US
Mailing Address - Phone:804-272-0563
Mailing Address - Fax:804-272-6077
Practice Address - Street 1:7834 FOREST HILL AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1974
Practice Address - Country:US
Practice Address - Phone:804-272-0563
Practice Address - Fax:804-272-6077
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010057831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice