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General NPI Number Information
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NPI Number | 1790033777
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Entity Type | Individual
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Provider Name | KATHRYN STROUD BULLWINKEL DMD
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Gender | Female
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Dates
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Enumeration Date | 08/22/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 405 W 5TH NORTH ST STE A
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City | SUMMERVILLE
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State | SC
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Zip | 29483-6515
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Country | US
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Telephone | 843-821-6433
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Fax | 843-821-6432
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Provider Business Mailing Address
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Address Line | 405 W 5TH NORTH ST STE A
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City | SUMMERVILLE
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State | SC
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Zip | 29483-6515
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Country | US
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Telephone | 843-821-6433
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Fax | 843-821-6432
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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 | 019028771
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8360
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License Number State | SC
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