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NPI Code Detail

MEDICARE: BLAKE HULT DDS

MEDICARE: BLAKE HULT 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 DentistryD1263SD

General Provider Information

NPI Number : 1912521766
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE HULT DDS
Provider Business Mailing Address
First Line : 1110 W 5TH ST
Second Line :
City : CANTON
State : SD
Zip : 57013-1543
Country : US
Telephone Number : 605-764-3179
Fax Number :
Provider Business Practice Location Address
First Line : 1110 W 5TH ST
Second Line :
City : CANTON
State : SD
Zip : 57013-1543
Country : US
Telephone Number : 605-764-3179
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2020
Last Update Date : 06/07/2020

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Directions to “ BLAKE HULT DDS” Practice Location

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