Healthcare Provider Details

I. General information

NPI: 1164765319
Provider Name (Legal Business Name): HULL FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 NANTASKET AVE
HULL MA
02045-2927
US

IV. Provider business mailing address

278 NANTASKET AVE
HULL MA
02045-2927
US

V. Phone/Fax

Practice location:
  • Phone: 781-925-3303
  • Fax: 781-925-9210
Mailing address:
  • Phone: 781-925-3303
  • Fax: 781-925-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1855991
License Number StateMA

VIII. Authorized Official

Name: MAURICE G LUSSIER
Title or Position: PRESIDENT
Credential:
Phone: 781-925-3303