Healthcare Provider Details

I. General information

NPI: 1396435319
Provider Name (Legal Business Name): ANGELINA CHERISE HULL LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 DURSTON RD STE 32
BOZEMAN MT
59718-2805
US

IV. Provider business mailing address

2149 DURSTON RD STE 32
BOZEMAN MT
59718-2805
US

V. Phone/Fax

Practice location:
  • Phone: 406-640-4723
  • Fax:
Mailing address:
  • Phone: 406-471-2156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number23732
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: