Provider Demographics
NPI:1093171431
Name:FLANNERY/BULLINGTON/RAPETTI
Entity Type:Organization
Organization Name:FLANNERY/BULLINGTON/RAPETTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BULLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-364-7188
Mailing Address - Street 1:736 W INGOMAR RD UNIT 35
Mailing Address - Street 2:
Mailing Address - City:INGOMAR
Mailing Address - State:PA
Mailing Address - Zip Code:15127-6623
Mailing Address - Country:US
Mailing Address - Phone:412-364-7188
Mailing Address - Fax:
Practice Address - Street 1:736 INGOMAR RD BOX 35
Practice Address - Street 2:
Practice Address - City:INGOMAR
Practice Address - State:PA
Practice Address - Zip Code:15127
Practice Address - Country:US
Practice Address - Phone:412-364-7188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty