Healthcare Provider Details

I. General information

NPI: 1639204944
Provider Name (Legal Business Name): THOMAS JOSEPH HULLER SR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 DIXIE HWY
PARK HILLS KY
41011-2852
US

IV. Provider business mailing address

1518 DIXIE HWY
PARK HILLS KY
41011-2852
US

V. Phone/Fax

Practice location:
  • Phone: 859-431-3254
  • Fax:
Mailing address:
  • Phone: 859-431-3254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4215
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: