Justin Tullis, D.D.S

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

204256 Issued in CO

Practice address

320 E Fontanero St Ste 307
Colorado Springs, CO 80907-7526

Phone

(719) 475-9023

Fax

(719) 475-9009

NPI assigned

Mar 1, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 18, 2022 through Jan 18, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1497115752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 E FONTANERO ST STE 307",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809077526",
            "telephone_number": "719-475-9023",
            "fax_number": "719-475-9009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 E FONTANERO ST STE 307",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809077526",
            "telephone_number": "719-475-9023",
            "fax_number": "719-475-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLIS",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-01",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "204256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "204256",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Sue-Perantoni Tuffield, NP
• Siena Tugendrajch, PHD
• Rylee Ann Tuggle
• Debra Ann Tulanowski, PMHNP-BC
• Ian R Tullberg, MD
• Laura Tullis, APRN
• Phyllis Tully, LPCC
• Bretina Asiana Tumblin
• Kristine Tunehorst, PT
• Patricia S. Tuning, PSY.D.

• Periodontics in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Periodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.