Healthcare Provider Details

I. General information

NPI: 1104857606
Provider Name (Legal Business Name): ROBERT C. HULL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N LEE HWY STE 1
LEXINGTON VA
24450-3759
US

IV. Provider business mailing address

650 N. LEE HWY STE 1
LEXINGTON VA
24450
US

V. Phone/Fax

Practice location:
  • Phone: 540-463-3826
  • Fax: 540-463-4819
Mailing address:
  • Phone: 540-463-3826
  • Fax: 540-463-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401410207
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: