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General NPI Number Information
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NPI Number | 1366893737
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Entity Type | Individual
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Provider Name | CLARA GULLEY DDS
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Gender | Female
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 402 S WASHINGTON AVE
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City | LIVINGSTON
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State | TX
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Zip | 77351-3447
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Country | US
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Telephone | 362-621-9119
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 CITYWEST BLVD BUILDING 4 SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77042-2853
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 31676
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License Number State | TX
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