Provider Demographics
NPI:1780808303
Name:HULSE, JARETT (DMD)
Entity type:Individual
Prefix:DR
First Name:JARETT
Middle Name:
Last Name:HULSE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1535
Mailing Address - Country:US
Mailing Address - Phone:210-928-2814
Mailing Address - Fax:210-928-2364
Practice Address - Street 1:4534 WESTGATE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-892-5988
Practice Address - Fax:512-892-4064
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053028-1122300000X
TX26277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02817485Medicaid