Healthcare Provider Details

I. General information

NPI: 1518187913
Provider Name (Legal Business Name): JON GERARD HULLINGS D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 N ROCK RD F-100
WICHITA KS
67206-1269
US

IV. Provider business mailing address

1223 N ROCK RD F-100
WICHITA KS
67206-1269
US

V. Phone/Fax

Practice location:
  • Phone: 316-636-1980
  • Fax: 316-636-1984
Mailing address:
  • Phone: 316-636-1980
  • Fax: 316-636-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6659
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: