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Individual
DR. JUSTIN TULLIS
Active
Individual
DR. JUSTIN TULLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
204256
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204256
DENTAL LICENSE NUMBER
CO
Enumeration date
03/01/2016
Last updated
01/19/2022
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