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General NPI Number Information
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NPI Number | 1376231324
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Entity Type | Individual
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Provider Name | MITCHEL BULGER
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Gender | Male
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 4102 CLEAR CREEK RD STE 102
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City | KILLEEN
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State | TX
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Zip | 76549-5954
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Country | US
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Telephone | 810-706-0679
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Fax |
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Provider Business Mailing Address
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Address Line | 316 N 35TH ST APT 20
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City | OMAHA
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State | NE
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Zip | 68131-2426
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Country | US
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Telephone | 810-706-0679
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 39522
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License Number State | TX
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