=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255289591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR PULL IT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2026
-----------------------------------------------------
Last Update Date | 03/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 GARDNER AVE STE 4
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53105-2160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-835-8115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 GARDNER AVE STE 4
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53105-2160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | TED HWANG
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 248-835-8115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------