Provider Demographics
NPI:1184780421
Name:HULL, MACKAY JOSEPH (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:MACKAY
Middle Name:JOSEPH
Last Name:HULL
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-4227
Mailing Address - Country:US
Mailing Address - Phone:406-247-3333
Mailing Address - Fax:
Practice Address - Street 1:123 S 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-4227
Practice Address - Country:US
Practice Address - Phone:406-247-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14811223S0112X, 1223D0001X
MT4090208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT10530OtherBLUE CROSS BLUE SHIELD
WY112397100OtherTITLE XIX - GROUP
IA05577OtherDENTIST
WY1161OtherDENTIST
MT12-5437Medicaid
WY102867700OtherTITLE XIX - INDIVIDUAL
MT4090OtherMEDICAL DOCTOR
MT1481OtherDENTIST
NE4368OtherDENTIST
MT04-2887Medicaid
1053OtherPIN
1053OtherPIN
81-0384741OtherEIN
WY112397100OtherTITLE XIX - GROUP
D20617Medicare UPIN