Provider Demographics
NPI:1114120573
Name:DULLE, PAUL VICTOR III (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VICTOR
Last Name:DULLE
Suffix:III
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 1:225 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3202
Mailing Address - Country:US
Mailing Address - Phone:573-634-3939
Mailing Address - Fax:573-634-8600
Practice Address - Street 1:225 MADISON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3202
Practice Address - Country:US
Practice Address - Phone:573-634-3939
Practice Address - Fax:573-634-8600
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0134651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice