Provider Demographics
NPI:1568781425
Name:PULLMAN, CHAUNTELL LANAE (DDS)
Entity Type:Individual
Prefix:
First Name:CHAUNTELL
Middle Name:LANAE
Last Name:PULLMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4574 LAWRENCEVILLE HWY NW STE 120
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3605
Mailing Address - Country:US
Mailing Address - Phone:770-921-9000
Mailing Address - Fax:
Practice Address - Street 1:4574 LAWRENCEVILLE HWY NW STE 120
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3605
Practice Address - Country:US
Practice Address - Phone:770-921-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist