Healthcare Provider Details

I. General information

NPI: 1295871515
Provider Name (Legal Business Name): DR. DONALD FREDERICK HULL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 MONTGOMERY DR STE B
SANTA ROSA CA
95405-5283
US

IV. Provider business mailing address

25445 ADOBE LN
LOS ALTOS HILLS CA
94022-4502
US

V. Phone/Fax

Practice location:
  • Phone: 707-537-2020
  • Fax: 707-537-2025
Mailing address:
  • Phone: 707-537-2020
  • Fax: 714-571-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number19750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: