MEDICARE: CHRISTOPHER MARC BULCHER DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2901601978	MI

General Provider Information

NPI Number	:	1528598992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MARC BULCHER DMD

Provider Business Mailing Address
First Line	:	4349 SAWKAW DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1768
Country	:	US
Telephone Number	:	616-361-7327
Fax Number	:

Provider Business Practice Location Address
First Line	:	4349 SAWKAW DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1768
Country	:	US
Telephone Number	:	616-361-7327
Fax Number	:

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

Provider Enumeration Date	:	06/18/2017
Last Update Date	:	09/29/2024

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