Healthcare Provider Details

I. General information

NPI: 1447801386
Provider Name (Legal Business Name): HULL FAMILY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 NANTASKET AVE
HULL MA
02045-2535
US

IV. Provider business mailing address

529 NANTASKET AVE
HULL MA
02045-2535
US

V. Phone/Fax

Practice location:
  • Phone: 781-925-5100
  • Fax:
Mailing address:
  • Phone: 781-925-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MUNAL S SALEM
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 781-367-3369