Provider Demographics
NPI:1487665220
Name:HULL, KALLEN K (DMD)
Entity Type:Individual
Prefix:MR
First Name:KALLEN
Middle Name:K
Last Name:HULL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MAIN ST
Mailing Address - Street 2:301
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3306
Mailing Address - Country:US
Mailing Address - Phone:617-605-2277
Mailing Address - Fax:
Practice Address - Street 1:274 MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3669
Practice Address - Country:US
Practice Address - Phone:781-640-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice