MEDICARE: GARY R. PULFER 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	1223G0001X	General Practice Dentistry	12006979	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467549600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY R. PULFER DDS, PC

Provider Business Mailing Address
First Line	:	1405 MEDICAL PARK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5831
Country	:	US
Telephone Number	:	260-482-4483
Fax Number	:	260-471-9889

Provider Business Practice Location Address
First Line	:	1405 MEDICAL PARK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5831
Country	:	US
Telephone Number	:	260-482-4483
Fax Number	:	260-471-9889

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY RAY PULFER
Credential	:	DDS
Telephone Number	:	260-482-4483

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	07/08/2008

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