# THOMAS R. HULL D.D.S.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134457153
- **Authorized official:** DR. THOMAS R. HULL D.D.S. (DENTIST)
- **Authorized official phone:** (208) 852-0194

## Contact information

- **Practice address:** 35 S STATE ST, PRESTON, ID 83263-1239
- **Practice address phone:** (208) 852-0194
- **Practice address fax:** (208) 852-3817
- **Mailing address:** 35 S STATE ST, PRESTON, ID 83263-1239
- **Mailing address phone:** (208) 852-0194
- **Mailing address fax:** (208) 852-3817

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D-1973 | ID | Yes |

## Other

- **Enumeration date:** 12/02/2009
- **Last updated:** 12/02/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000837000 | — | ID |
| 01 | — | 6357-8 | BLUE CROSS OF IDAHO | — |
| 01 | — | 816458 | UNITED CONCORDIA | — |