Healthcare Provider Details

I. General information

NPI: 1679588263
Provider Name (Legal Business Name): HULSE DENTAL PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7424 S. NORTHSHORE DRIVE
KNOXVILLE TN
37919
US

IV. Provider business mailing address

7424 S. NORTHSHORE DRIVE
KNOXVILLE TN
37919
US

V. Phone/Fax

Practice location:
  • Phone: 865-804-2465
  • Fax: 865-671-3067
Mailing address:
  • Phone: 865-804-2465
  • Fax: 865-671-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSSELL ARBREY HULSE
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 865-640-5565