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General NPI Number Information
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NPI Number | 1699001644
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Entity Type | Organization
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Legal Business Name | JEREMY C. DULL DDS PC
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 876 STEWART RD. SUITE D
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City | MONROE
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State | MI
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Zip | 48162
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Country | US
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Telephone | 734-241-6550
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Fax | 734-241-0824
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Provider Business Mailing Address
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Address Line | 876 STEWART RD. SUITE D
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City | MONROE
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State | MI
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Zip | 48162
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Country | US
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Telephone | 734-241-6550
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Fax | 734-241-0824
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JEREMY CHRISTOPHER DULL
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Credential | D.D.S.
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Telephone | 734-241-6550
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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 | 2901017992
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License Number State | MI
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