Individual
DR. JOHN ROBERT ULLOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1680 15TH AVE, UNION GROVE, WI 53182-1525
(262) 878-1500
(262) 878-4782
Mailing address
1680 15TH AVE, UNION GROVE, WI 53182-1525
(262) 878-1500
(262) 878-4782
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4398
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
391841902
TAX ID
WI
Enumeration date
07/29/2008
Last updated
07/29/2008
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