Provider Demographics
NPI:1255522330
Name:TULL ORAL AND FACIAL SURGERY
Entity type:Organization
Organization Name:TULL ORAL AND FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:T
Authorized Official - Last Name:TULL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:913-888-9300
Mailing Address - Street 1:12541 FOSTER ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2630
Mailing Address - Country:US
Mailing Address - Phone:913-888-9300
Mailing Address - Fax:913-541-1108
Practice Address - Street 1:12541 FOSTER ST
Practice Address - Street 2:SUITE 330
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2630
Practice Address - Country:US
Practice Address - Phone:913-888-9300
Practice Address - Fax:913-541-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60285261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental