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General NPI Number Information
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NPI Number | 1912531955
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Entity Type | Individual
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Provider Name | MICHAEL RYAN GULLEY DDS
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Gender | Male
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 100 PIPER HILL DR STE A
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City | SAINT PETERS
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State | MO
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Zip | 63376-1616
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Country | US
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Telephone | 636-477-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 7724 CHERRY ST
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City | KANSAS CITY
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State | MO
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Zip | 64131-2068
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Country | US
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Telephone | 314-258-0593
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2019019274
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License Number State | MO
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