Provider Demographics
NPI:1275983603
Name:DONALD W PULVER,DDS,PC
Entity Type:Organization
Organization Name:DONALD W PULVER,DDS,PC
Other - Org Name:PULVER DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:PULVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-696-4940
Mailing Address - Street 1:501 E COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1816
Mailing Address - Country:US
Mailing Address - Phone:219-696-4940
Mailing Address - Fax:219-696-4800
Practice Address - Street 1:501 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1816
Practice Address - Country:US
Practice Address - Phone:219-696-4940
Practice Address - Fax:219-696-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008026A122300000X
IN12012413A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty