MEDICARE: DR. JENNA T PULKKA D.M.D

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	DEN4065	ME

General Provider Information

NPI Number	:	1528221116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNA T PULKKA D.M.D

Provider Business Mailing Address
First Line	:	568 LISBON ST
Second Line	:	SUITE 1
City	:	LISBON FALLS
State	:	ME
Zip	:	04252-1138
Country	:	US
Telephone Number	:	207-407-4301
Fax Number	:

Provider Business Practice Location Address
First Line	:	568 LISBON ST
Second Line	:	SUITE 1
City	:	LISBON FALLS
State	:	ME
Zip	:	04252-1138
Country	:	US
Telephone Number	:	207-407-4301
Fax Number	:

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

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	03/23/2015

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