MEDICARE: DR. MICHAEL R. HULL JR. 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	4978	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	636095	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1881604981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R. HULL JR. DDS

Provider Business Mailing Address
First Line	:	4701 W INDIAN SCHOOL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85031-2719
Country	:	US
Telephone Number	:	623-245-8461
Fax Number	:	623-247-0444

Provider Business Practice Location Address
First Line	:	720 E THUNDERBIRD RD STE 2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5396
Country	:	US
Telephone Number	:	602-863-3000
Fax Number	:

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	11/08/2019

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