Healthcare Provider Details

I. General information

NPI: 1144387622
Provider Name (Legal Business Name): BENJAMIN RODNEY HULSE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402 LANDSTUHL DENTAL ACTIVITY CRDENTIALS OFFICE
APO AE NY
09180
US

IV. Provider business mailing address

CMR 402 LANDSTUHL DENTAL ACTIVITY CRDENTIALS OFFICE
APO AE NY
09180
US

V. Phone/Fax

Practice location:
  • Phone: 637-192-9130
  • Fax:
Mailing address:
  • Phone: 637-192-9130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number08430
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: