Provider Demographics
NPI:1386162782
Name:MIKE PULIDO DDS
Entity type:Organization
Organization Name:MIKE PULIDO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PULIDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-756-0688
Mailing Address - Street 1:8590 FARMINGTON BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-3344
Mailing Address - Country:US
Mailing Address - Phone:901-756-0688
Mailing Address - Fax:901-756-0838
Practice Address - Street 1:8590 FARMINGTON BLVD STE 5
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-3344
Practice Address - Country:US
Practice Address - Phone:901-756-0688
Practice Address - Fax:901-756-0838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental