Provider Demographics
NPI:1225403991
Name:JOHN W BULL DDS
Entity Type:Organization
Organization Name:JOHN W BULL DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BULL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-243-2855
Mailing Address - Street 1:2226 DOGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8402
Mailing Address - Country:US
Mailing Address - Phone:970-243-2855
Mailing Address - Fax:970-256-9467
Practice Address - Street 1:2901 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-2811
Practice Address - Country:US
Practice Address - Phone:970-243-2855
Practice Address - Fax:970-256-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN00000167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02001675Medicaid