MEDICARE: DR. WILLIAM LAWRENCE HULL III DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12013087A	IN

General Provider Information

NPI Number	:	1639483647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM LAWRENCE HULL III DMD

Provider Business Mailing Address
First Line	:	3367 DOUGLAS RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635-1779
Country	:	US
Telephone Number	:	574-272-8823
Fax Number	:	574-277-1837

Provider Business Practice Location Address
First Line	:	3367 DOUGLAS RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635-1779
Country	:	US
Telephone Number	:	574-272-8823
Fax Number	:	574-277-1837

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

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	12/21/2021

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