Provider Demographics
NPI:1285919555
Name:BULL MOUNTAIN FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:BULL MOUNTAIN FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-901-7345
Mailing Address - Street 1:15885 SW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2647
Mailing Address - Country:US
Mailing Address - Phone:503-901-7345
Mailing Address - Fax:
Practice Address - Street 1:15885 SW 116TH AVE
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-2647
Practice Address - Country:US
Practice Address - Phone:503-901-7345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8974261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental