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General NPI Number Information
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NPI Number | 1376044909
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Entity Type | Organization
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Legal Business Name | PETER L BULTHUIS DDS PC
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 5625 MIDDLEBELT RD
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City | GARDEN CITY
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State | MI
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Zip | 48135-2457
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Country | US
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Telephone | 734-422-1332
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Fax | 734-422-1335
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Provider Business Mailing Address
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Address Line | 5625 MIDDLEBELT RD
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City | GARDEN CITY
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State | MI
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Zip | 48135-2457
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Country | US
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Telephone | 734-422-1332
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Fax | 734-422-1335
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PETER L BULTHUIS
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Credential | DDS
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Telephone | 734-422-1332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 13246
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License Number State | MI
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