Healthcare Provider Details

I. General information

NPI: 1871025072
Provider Name (Legal Business Name): BULVERDE DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20248 STATE HIGHWAY 46 W STE 140
SPRING BRANCH TX
78070-6894
US

IV. Provider business mailing address

17000 RED HILL AVE
IRVINE CA
92614-5626
US

V. Phone/Fax

Practice location:
  • Phone: 830-201-1085
  • Fax: 830-455-4014
Mailing address:
  • Phone: 714-845-8890
  • Fax: 949-474-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN BARNES
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 830-201-1085