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NPI Code Detail

MEDICARE: DR. JUSTIN TULLIS D.D.S

MEDICARE: DR. JUSTIN TULLIS 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
1390200000XStudent in an Organized Health Care Education/Training ProgramMO
21223P0300XPeriodontics204256CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1204256OTHERCODENTAL LICENSE NUMBER

General Provider Information

NPI Number : 1497115752
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN TULLIS D.D.S
Provider Business Mailing Address
First Line : 320 E FONTANERO ST STE 307
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-7526
Country : US
Telephone Number : 719-475-9023
Fax Number : 719-475-9009
Provider Business Practice Location Address
First Line : 320 E FONTANERO ST STE 307
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-7526
Country : US
Telephone Number : 719-475-9023
Fax Number : 719-475-9009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2016
Last Update Date : 01/19/2022

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