Provider Demographics
NPI:1033149018
Name:BULFORD, LIONEL ANGELO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:ANGELO
Last Name:BULFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CARE LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8624
Mailing Address - Country:US
Mailing Address - Phone:518-583-4497
Mailing Address - Fax:518-583-3779
Practice Address - Street 1:4 CARE LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8624
Practice Address - Country:US
Practice Address - Phone:518-583-4497
Practice Address - Fax:518-583-3779
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0439281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U71741Medicare UPIN
BB1976Medicare ID - Type Unspecified