MEDICARE: DR. RUSSELL ARBREY HULSE 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	1223G0001X	General Practice Dentistry	DS8165	TN

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	:	1700875671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL ARBREY HULSE DDS

Provider Business Mailing Address
First Line	:	1203 OLD N KENTUCKY ST
Second Line	:
City	:	KINGSTON
State	:	TN
Zip	:	37763-2358
Country	:	US
Telephone Number	:	865-717-3586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 N KENTUCKY ST
Second Line	:
City	:	KINGSTON
State	:	TN
Zip	:	37763-2328
Country	:	US
Telephone Number	:	865-717-3586
Fax Number	:

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	08/16/2012

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