Provider Demographics
NPI:1508141839
Name:HULL, MICHAEL WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:HULL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9157 MONTGOMERY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7731
Mailing Address - Country:US
Mailing Address - Phone:513-793-2611
Mailing Address - Fax:513-793-9123
Practice Address - Street 1:9157 MONTGOMERY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7731
Practice Address - Country:US
Practice Address - Phone:513-793-2611
Practice Address - Fax:513-793-9123
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0232421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice