Healthcare Provider Details

I. General information

NPI: 1962698100
Provider Name (Legal Business Name): REID VICTOR PULLEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 E LAMBERT RD STE 230
BREA CA
92821-4372
US

IV. Provider business mailing address

1770 E LAMBERT RD STE 230
BREA CA
92821-4372
US

V. Phone/Fax

Practice location:
  • Phone: 714-529-9029
  • Fax:
Mailing address:
  • Phone: 714-529-9029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number46323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: