Provider Demographics
NPI:1043589153
Name:BULL FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:BULL FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:BULL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-262-1312
Mailing Address - Street 1:1517 S 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-4009
Mailing Address - Country:US
Mailing Address - Phone:928-348-9181
Mailing Address - Fax:928-348-7820
Practice Address - Street 1:1517 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4009
Practice Address - Country:US
Practice Address - Phone:928-348-9181
Practice Address - Fax:928-348-7820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7220122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty