Provider Demographics
NPI:1457475527
Name:MARK HULS D.M.D., P.C.
Entity Type:Organization
Organization Name:MARK HULS D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:HULS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-352-4334
Mailing Address - Street 1:481 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7230
Mailing Address - Country:US
Mailing Address - Phone:217-352-4334
Mailing Address - Fax:217-398-7837
Practice Address - Street 1:481 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7230
Practice Address - Country:US
Practice Address - Phone:217-352-4334
Practice Address - Fax:217-398-7837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental