Provider Demographics
NPI:1306338066
Name:BULLEN ORTHODONTICS INC.
Entity type:Organization
Organization Name:BULLEN ORTHODONTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-787-6883
Mailing Address - Street 1:1143 RIATA VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409
Mailing Address - Country:US
Mailing Address - Phone:928-757-8700
Mailing Address - Fax:928-757-0399
Practice Address - Street 1:1143 RIATA VALLEY RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409
Practice Address - Country:US
Practice Address - Phone:928-757-8700
Practice Address - Fax:928-757-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD39271223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty