MEDICARE: RACHEL BRINKLEY PULLIN DDS

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	0401414882	VA

General Provider Information

NPI Number	:	1619358082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL BRINKLEY PULLIN DDS

Provider Business Mailing Address
First Line	:	112 CANTERBURY RD
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-2624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4035 RIVERSIDE DR
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-5152
Country	:	US
Telephone Number	:	434-793-2045
Fax Number	:	434-793-8820

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

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	10/19/2016

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