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General NPI Number Information
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NPI Number | 1306338066
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Entity Type | Organization
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Legal Business Name | BULLEN ORTHODONTICS INC.
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 1143 RIATA VALLEY RD
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City | KINGMAN
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State | AZ
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Zip | 86409
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Country | US
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Telephone | 928-757-8700
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Fax | 928-757-0399
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Provider Business Mailing Address
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Address Line | 1143 RIATA VALLEY RD
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City | KINGMAN
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State | AZ
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Zip | 86409
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Country | US
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Telephone | 928-757-8700
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Fax | 928-757-0399
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. RYAN N. BULLEN
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Credential |
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Telephone | 801-787-6883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D3927
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D3927
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License Number State | AZ
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