Provider Demographics
NPI:1699001644
Name:JEREMY C. DULL DDS PC
Entity Type:Organization
Organization Name:JEREMY C. DULL DDS PC
Other - Org Name:MONROE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:DULL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-241-6550
Mailing Address - Street 1:876 STEWART RD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162
Mailing Address - Country:US
Mailing Address - Phone:734-241-6550
Mailing Address - Fax:734-241-0824
Practice Address - Street 1:876 STEWART RD.
Practice Address - Street 2:SUITE D
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-241-6550
Practice Address - Fax:734-241-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010179921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty