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NPI Code Detail

MEDICARE: DR. DAVID ROY PULIDO DDS

MEDICARE: DR. DAVID ROY PULIDO 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
11223G0001XGeneral Practice DentistryDJ035969CA

General Provider Information

NPI Number : 1588757173
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID ROY PULIDO DDS
Provider Business Mailing Address
First Line : 1811 GRAND CANAL BLVD
Second Line : SUITE 1
City : STOCKTON
State : CA
Zip : 95207-8107
Country : US
Telephone Number : 209-474-2340
Fax Number : 209-474-2340
Provider Business Practice Location Address
First Line : 1811 GRAND CANAL BLVD
Second Line : SUITE 1
City : STOCKTON
State : CA
Zip : 95207-8107
Country : US
Telephone Number : 209-474-2340
Fax Number : 209-474-2340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 03/08/2023

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