Healthcare Provider Details

I. General information

NPI: 1285914176
Provider Name (Legal Business Name): ERIC D HULL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 YORK CREEK DR NW
COMSTOCK PARK MI
49321-8712
US

IV. Provider business mailing address

1905 STRATFORD LN
WALKER MI
49534-2181
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-2377
  • Fax: 616-784-0707
Mailing address:
  • Phone: 989-430-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901020583
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: