Individual
DR. JUSTIN TULLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
320 E FONTANERO ST STE 307, COLORADO SPRINGS, CO 80907-7526
(719) 475-9023
(719) 475-9009
Mailing address
320 E FONTANERO ST STE 307, COLORADO SPRINGS, CO 80907-7526
(719) 475-9023
(719) 475-9009
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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