Healthcare Provider Details

I. General information

NPI: 1831281179
Provider Name (Legal Business Name): R BRIAN ULLMANN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 WARREN AVE
HO HO KUS NJ
07423
US

IV. Provider business mailing address

312 WARREN AVE
HO HO KUS NJ
07423
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-9777
  • Fax: 201-612-0423
Mailing address:
  • Phone: 201-444-9777
  • Fax: 201-612-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number8720
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: