Healthcare Provider Details

I. General information

NPI: 1689686735
Provider Name (Legal Business Name): MARK HULS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 DEVONSHIRE DR
CHAMPAIGN IL
61820-7230
US

IV. Provider business mailing address

481 DEVONSHIRE DR
CHAMPAIGN IL
61820-7230
US

V. Phone/Fax

Practice location:
  • Phone: 217-352-4334
  • Fax:
Mailing address:
  • Phone: 217-352-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: