Provider Demographics
NPI:1922240514
Name:PULIDO, HERNANDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:HERNANDO
Middle Name:
Last Name:PULIDO
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 1:101 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3324
Mailing Address - Country:US
Mailing Address - Phone:732-363-6655
Mailing Address - Fax:732-901-0277
Practice Address - Street 1:101 2ND ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3324
Practice Address - Country:US
Practice Address - Phone:732-363-6655
Practice Address - Fax:732-901-0277
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024130001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0200735Medicaid
MI5315036276OtherCONTROLLED SUBSTANCE