MEDICARE: DONALD W PULVER,DDS,PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12012413A	IN
2	122300000X	Dentist	12008026A	IN

General Provider Information

NPI Number	:	1275983603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD W PULVER,DDS,PC

Provider Business Mailing Address
First Line	:	501 E COMMERCIAL AVE
Second Line	:
City	:	LOWELL
State	:	IN
Zip	:	46356-1816
Country	:	US
Telephone Number	:	219-696-4940
Fax Number	:	219-696-4800

Provider Business Practice Location Address
First Line	:	501 E COMMERCIAL AVE
Second Line	:
City	:	LOWELL
State	:	IN
Zip	:	46356-1816
Country	:	US
Telephone Number	:	219-696-4940
Fax Number	:	219-696-4800

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD W PULVER
Credential	:	DDS
Telephone Number	:	219-696-4940

Provider Enumeration Date	:	06/16/2016
Last Update Date	:	06/16/2016

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