Healthcare Provider Details

I. General information

NPI: 1003977281
Provider Name (Legal Business Name): BARNEY LEE PULLEN JR. D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 WOOD ST
WATER VALLEY MS
38965
US

IV. Provider business mailing address

117 WOOD ST
WATER VALLEY MS
38965
US

V. Phone/Fax

Practice location:
  • Phone: 662-473-2296
  • Fax: 662-473-2313
Mailing address:
  • Phone: 662-473-2296
  • Fax: 662-473-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2836-94
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: