Healthcare Provider Details

I. General information

NPI: 1346595576
Provider Name (Legal Business Name): CAL THOMAS BULLOCK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CENTRAL AVE
BILLINGS MT
59102-8626
US

IV. Provider business mailing address

2900 CENTRAL AVE
BILLINGS MT
59102-8626
US

V. Phone/Fax

Practice location:
  • Phone: 406-646-6100
  • Fax:
Mailing address:
  • Phone: 406-656-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberLL633
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberLL674
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN-DEN-LIC-7748
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: