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General NPI Number Information
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NPI Number | 1265706527
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Entity Type | Organization
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Legal Business Name | W.L. BULLIS, D.D.S.,P.C.
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 3409 S GEORGIA ST STE 12
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City | AMARILLO
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State | TX
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Zip | 79109-4844
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Country | US
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Telephone | 806-359-0371
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Fax | 806-463-5205
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Provider Business Mailing Address
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Address Line | 3409 S GEORGIA ST STE 12
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City | AMARILLO
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State | TX
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Zip | 79109-4844
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Country | US
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Telephone | 806-359-0371
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Fax | 806-463-5205
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Authorized Official
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Title or Position | P.C.
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Name | W. L. BULLIS
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Credential | D.D.S.
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Telephone | 806-359-0371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 08404
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License Number State | TX
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