Provider Demographics
NPI:1508986951
Name:STRULL & STRULL, PSC
Entity Type:Organization
Organization Name:STRULL & STRULL, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:STRULL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-896-4401
Mailing Address - Street 1:4122 SHELBYVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3212
Mailing Address - Country:US
Mailing Address - Phone:502-896-4401
Mailing Address - Fax:502-893-4930
Practice Address - Street 1:4122 SHELBYVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3242
Practice Address - Country:US
Practice Address - Phone:502-896-4401
Practice Address - Fax:502-893-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100001530AMedicaid
KY2691Medicare PIN