Provider Demographics
NPI:1356330229
Name:HULSE, EVON ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVON
Middle Name:ELIZABETH
Last Name:HULSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 OLD N KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-2358
Mailing Address - Country:US
Mailing Address - Phone:865-717-3586
Mailing Address - Fax:865-717-3581
Practice Address - Street 1:1212 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2328
Practice Address - Country:US
Practice Address - Phone:865-717-3586
Practice Address - Fax:865-717-3581
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS81101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3633621Medicaid