Organization
PUCKETT FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE TULLOS DMD (DENTIST/OWNER)
(601) 825-0559
Entity
Organization
Contact information
Practice address
6181 HIGHWAY 18, BRANDON, MS 39042-0000
(601) 825-0559
Mailing address
6181 HIGHWAY 18, BRANDON, MS 39042-0000
(601) 825-0559
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
326503
MS
Other
Enumeration date
06/16/2008
Last updated
06/16/2008
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