Provider Demographics
NPI:1104857606
Name:HULL, ROBERT C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:HULL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N. LEE HWY
Mailing Address - Street 2:STE 1
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450
Mailing Address - Country:US
Mailing Address - Phone:540-463-3826
Mailing Address - Fax:540-463-4819
Practice Address - Street 1:650 N LEE HWY
Practice Address - Street 2:STE 1
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-3759
Practice Address - Country:US
Practice Address - Phone:540-463-3826
Practice Address - Fax:540-463-4819
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014102071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0012550Medicaid