Provider Demographics
NPI:1104831759
Name:STULL, JERI LYNNETTE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:LYNNETTE
Last Name:STULL
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1746
Mailing Address - Country:US
Mailing Address - Phone:859-781-2662
Mailing Address - Fax:859-781-1029
Practice Address - Street 1:637 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1746
Practice Address - Country:US
Practice Address - Phone:859-781-2662
Practice Address - Fax:859-781-1029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics