MEDICARE: DR. JAMES EDWARD ULLMER II D.D.S

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	13772	OH

General Provider Information

NPI Number	:	1467517433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EDWARD ULLMER II D.D.S

Provider Business Mailing Address
First Line	:	5925 N MAIN ST
Second Line	:	SUITE D
City	:	DAYTON
State	:	OH
Zip	:	45415-3153
Country	:	US
Telephone Number	:	937-276-5871
Fax Number	:

Provider Business Practice Location Address
First Line	:	5925 N MAIN ST
Second Line	:	SUITE D
City	:	DAYTON
State	:	OH
Zip	:	45415-3153
Country	:	US
Telephone Number	:	937-276-5871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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