MEDICARE: DR. THOMAS DAVID PULLIAM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN5081	FL

General Provider Information

NPI Number	:	1417965872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS DAVID PULLIAM DDS

Provider Business Mailing Address
First Line	:	4446 E FLETCHER AVE
Second Line	:	SUITE-F
City	:	TAMPA
State	:	FL
Zip	:	33613-4942
Country	:	US
Telephone Number	:	813-910-2345
Fax Number	:	813-910-8929

Provider Business Practice Location Address
First Line	:	4446 E FLETCHER AVE
Second Line	:	SUITE-F
City	:	TAMPA
State	:	FL
Zip	:	33613-4942
Country	:	US
Telephone Number	:	813-910-2345
Fax Number	:	813-910-8929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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