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General NPI Number Information
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NPI Number | 1851065627
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Entity Type | Organization
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Legal Business Name | TULLY AND MOKBIL DENTAL CORPORATION
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 2228 FAIR OAKS BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95825-5502
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Country | US
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Telephone | 916-432-2842
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Fax | 916-458-4804
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Provider Business Mailing Address
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Address Line | PO BOX 920050
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City | DALLAS
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State | TX
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Zip | 75392-0050
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Country | US
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Telephone | 714-845-8890
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Fax | 303-952-0892
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Authorized Official
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Title or Position | OWNER
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Name | NATHAN TULLY
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Credential | DMD
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Telephone | 916-432-2842
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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 |
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License Number State |
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