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General NPI Number Information
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NPI Number | 1962899666
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Entity Type | Organization
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Legal Business Name | RICHARD ARTHUR BULLOCK DDS
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 72027 DESERT DR
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4959
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Country | US
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Telephone | 760-340-5107
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Fax | 760-340-0315
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Provider Business Mailing Address
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Address Line | 72027 DESERT DR
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4959
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Country | US
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Telephone | 760-340-5107
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Fax | 760-340-0315
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD ARTHUR BULLOCK
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Credential | DDS
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Telephone | 760-340-5107
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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 | 028127
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License Number State | CA
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