Provider Demographics
NPI:1841370194
Name:DULL, DWAYNE SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:SCOTT
Last Name:DULL
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 1:14441 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079
Mailing Address - Country:US
Mailing Address - Phone:281-497-3382
Mailing Address - Fax:281-497-8105
Practice Address - Street 1:14441 MEMORIAL DRIVE
Practice Address - Street 2:SUITE 21
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079
Practice Address - Country:US
Practice Address - Phone:281-497-3382
Practice Address - Fax:281-497-8105
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist