Provider Demographics
NPI:1851771521
Name:HULL, BENJAMIN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:D
Last Name:HULL
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 1:1323 HIGHWAY 2
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-5210
Mailing Address - Country:US
Mailing Address - Phone:208-263-1412
Mailing Address - Fax:
Practice Address - Street 1:1323 HIGHWAY 2
Practice Address - Street 2:SUITE 301
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5210
Practice Address - Country:US
Practice Address - Phone:208-263-1412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-46601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice