| NPI | 1578642872 |
|---|---|
| Doing Business As | TULLY MOBILE DENTAL UNIT |
| Entity Type | Organization |
| Authorized Contact | ALFONSO F BANUELOS Chief Medical Officer 408-885-4001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 070000085) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CA 070000085) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-08-22 |