Provider Demographics
NPI:1972614295
Name:PULIDO, MIGUEL (DDS)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:PULIDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:PULIDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8590 FARMINGTON BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139
Mailing Address - Country:US
Mailing Address - Phone:901-756-0688
Mailing Address - Fax:901-756-0838
Practice Address - Street 1:8590 FARMINGTON BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139
Practice Address - Country:US
Practice Address - Phone:901-756-0688
Practice Address - Fax:901-756-0838
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4506122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist