Provider Demographics
NPI:1902016058
Name:PULSIPHER, DAVID CLYDE (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CLYDE
Last Name:PULSIPHER
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 1:39755 MURRIETA HOT SPRINGS RD
Mailing Address - Street 2:A-110
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-9101
Mailing Address - Country:US
Mailing Address - Phone:951-461-2310
Mailing Address - Fax:951-304-1295
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:A-110
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-9101
Practice Address - Country:US
Practice Address - Phone:951-461-2310
Practice Address - Fax:951-304-1295
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist