Provider Demographics
NPI:1619073699
Name:PULLEY, BRENT D (DMD, LTD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:D
Last Name:PULLEY
Suffix:
Gender:M
Credentials:DMD, LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 E CAROLINE LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3532
Mailing Address - Country:US
Mailing Address - Phone:480-839-0137
Mailing Address - Fax:
Practice Address - Street 1:1442 E CHANDLER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-6265
Practice Address - Country:US
Practice Address - Phone:480-460-1911
Practice Address - Fax:480-460-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ2103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist