Provider Demographics
NPI:1184490013
Name:PULLEY, PAMELA D (RDH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:PULLEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GOREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62939-2323
Mailing Address - Country:US
Mailing Address - Phone:618-995-1002
Mailing Address - Fax:
Practice Address - Street 1:211 N BROADWAY
Practice Address - Street 2:
Practice Address - City:GOREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62939-2323
Practice Address - Country:US
Practice Address - Phone:618-995-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist