Provider Demographics
NPI:1194701722
Name:BULL, DAVID J (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:BULL
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 1:9309 LA RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2437
Mailing Address - Country:US
Mailing Address - Phone:916-362-9257
Mailing Address - Fax:
Practice Address - Street 1:9309 LA RIVIERA DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2437
Practice Address - Country:US
Practice Address - Phone:916-362-9257
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA239191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice