Organization
TULLOS FAMILY DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE SULLIVAN TULLOS D.M.D. (DENTIST)
(601) 782-9909
Entity
Organization
Contact information
Practice address
276 MAGNOLIA DR, RALEIGH, MS 39153-6016
(601) 782-9909
(601) 782-9133
Mailing address
276 MAGNOLIA DR, RALEIGH, MS 39153-6016
(601) 782-9909
(601) 782-9133
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3265-03
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00529717
—
MS
Enumeration date
01/03/2007
Last updated
08/22/2020
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