Healthcare Provider Details

I. General information

NPI: 1871733972
Provider Name (Legal Business Name): PETER AKINS PULLON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 IRWIN LN
JUPITER FL
33458-4015
US

IV. Provider business mailing address

703 IRWIN LN
JUPITER FL
33458-4015
US

V. Phone/Fax

Practice location:
  • Phone: 561-628-2916
  • Fax:
Mailing address:
  • Phone: 561-628-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberFL8968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: