Healthcare Provider Details

I. General information

NPI: 1851127856
Provider Name (Legal Business Name): BULEM YUZUGULLU TUTUNCULER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

154 LAKEWAY DR
MADISON MS
39110
US

V. Phone/Fax

Practice location:
  • Phone: 888-815-2005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberPRV-TP-123-24
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: