Provider Demographics
NPI:1639204944
Name:HULLER, THOMAS JOSEPH SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:HULLER
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2852
Mailing Address - Country:US
Mailing Address - Phone:859-431-3254
Mailing Address - Fax:
Practice Address - Street 1:1518 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:KY
Practice Address - Zip Code:41011-2852
Practice Address - Country:US
Practice Address - Phone:859-431-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice