MEDICARE: DR. LIONEL ANGELO BULFORD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	043928	NY

General Provider Information

NPI Number	:	1033149018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIONEL ANGELO BULFORD DDS

Provider Business Mailing Address
First Line	:	4 CARE LN
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-8624
Country	:	US
Telephone Number	:	518-583-4497
Fax Number	:	518-583-3779

Provider Business Practice Location Address
First Line	:	4 CARE LN
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-8624
Country	:	US
Telephone Number	:	518-583-4497
Fax Number	:	518-583-3779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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