Provider Demographics
NPI:1154646198
Name:TROY C, HULL, DMD, PS
Entity Type:Organization
Organization Name:TROY C, HULL, DMD, PS
Other - Org Name:GREENLAKE KIDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD, MPH
Authorized Official - Phone:206-387-4131
Mailing Address - Street 1:6900 E GREEN LAKE WAY N
Mailing Address - Street 2:SUITE H
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5480
Mailing Address - Country:US
Mailing Address - Phone:206-387-4131
Mailing Address - Fax:
Practice Address - Street 1:6900 E GREEN LAKE WAY N
Practice Address - Street 2:SUITE H
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5480
Practice Address - Country:US
Practice Address - Phone:206-387-4131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty