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General NPI Number Information
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NPI Number | 1073983755
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Entity Type | Organization
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Legal Business Name | HULLETT DENTAL GROUP, PLLC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 24 GREENWAY PLZ STE 1708
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City | HOUSTON
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State | TX
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Zip | 77046-2417
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Country | US
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Telephone | 713-439-7575
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Fax |
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Provider Business Mailing Address
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Address Line | 24 GREENWAY PLZ STE 1708
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City | HOUSTON
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State | TX
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Zip | 77046-2417
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ORAL SURGEON
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Name | DR. JASON HULLETT
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Credential | DMD
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Telephone | 201-407-5181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 31059
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License Number State | TX
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