Provider Demographics
NPI:1396061743
Name:HULTMAN, VICTORIA ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ANNE
Last Name:HULTMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:ANNE
Other - Last Name:PETRUCCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:115 HALSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-4159
Mailing Address - Country:US
Mailing Address - Phone:914-835-3488
Mailing Address - Fax:914-835-3428
Practice Address - Street 1:115 HALSTEAD AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-4159
Practice Address - Country:US
Practice Address - Phone:914-835-3488
Practice Address - Fax:914-835-3428
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY055661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program