Provider Demographics
NPI:1629248950
Name:PULITZER, SAMUEL FLETTRICH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:FLETTRICH
Last Name:PULITZER
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 1:1335 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2489
Mailing Address - Country:US
Mailing Address - Phone:423-246-3001
Mailing Address - Fax:
Practice Address - Street 1:1335 E CENTER ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2489
Practice Address - Country:US
Practice Address - Phone:423-246-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics