Healthcare Provider Details

I. General information

NPI: 1578551701
Provider Name (Legal Business Name): ARDEN O PULLEY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 CHIPPEWA ST
SAINT LOUIS MO
63109-1635
US

IV. Provider business mailing address

2659 WILLOW RUN CT
SAINT LOUIS MO
63129-4718
US

V. Phone/Fax

Practice location:
  • Phone: 314-752-0239
  • Fax:
Mailing address:
  • Phone: 314-846-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE 012590
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: