Provider Demographics
NPI:1073983755
Name:HULLETT DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:HULLETT DENTAL GROUP, PLLC
Other - Org Name:SOUTHWEST ORAL AND IMPLANT SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HULLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-407-5181
Mailing Address - Street 1:24 GREENWAY PLZ STE 1708
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-2417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 GREENWAY PLZ STE 1708
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-2417
Practice Address - Country:US
Practice Address - Phone:713-439-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty