Healthcare Provider Details

I. General information

NPI: 1730273756
Provider Name (Legal Business Name): RONALD FRED HULL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 KENNESAW AVE NW SUITE 5
MARIETTA GA
30060-7933
US

IV. Provider business mailing address

840 KENNESAW AVE NW SUITE 5
MARIETTA GA
30060-7933
US

V. Phone/Fax

Practice location:
  • Phone: 770-428-1919
  • Fax: 770-425-0055
Mailing address:
  • Phone: 770-428-1919
  • Fax: 770-425-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8773
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: