MEDICARE: DR. CRAIG B. BULT D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4888	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y118	OTHER	KY	FEDERAL BC/BS KY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295737864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG B. BULT D.M.D.

Provider Business Mailing Address
First Line	:	4602 SOUTHERN PKWY
Second Line	:	SUITE 2E
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-1442
Country	:	US
Telephone Number	:	502-361-1232
Fax Number	:	502-361-1242

Provider Business Practice Location Address
First Line	:	4602 SOUTHERN PKWY
Second Line	:	SUITE 2E
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-1442
Country	:	US
Telephone Number	:	502-361-1232
Fax Number	:	502-361-1242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	01/11/2008

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