Provider Demographics
NPI:1528221116
Name:PULKKA, JENNA T (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:T
Last Name:PULKKA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 LISBON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LISBON FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04252-1138
Mailing Address - Country:US
Mailing Address - Phone:207-407-4301
Mailing Address - Fax:
Practice Address - Street 1:568 LISBON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LISBON FALLS
Practice Address - State:ME
Practice Address - Zip Code:04252-1138
Practice Address - Country:US
Practice Address - Phone:207-407-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN40651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice