Provider Demographics
NPI:1902143415
Name:TULLNER, JOHN BRADSHAW (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRADSHAW
Last Name:TULLNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 DITCHLEY RD
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-3302
Mailing Address - Country:US
Mailing Address - Phone:804-435-0306
Mailing Address - Fax:
Practice Address - Street 1:520 NORTH 12TH ST
Practice Address - Street 2:RM A-018
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0566
Practice Address - Country:US
Practice Address - Phone:804-828-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010082001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice