Provider Demographics
NPI:1235158247
Name:BULLARD, JAMES TODD
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TODD
Last Name:BULLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:TODD
Other - Last Name:BULLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1832 CARMEL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5821
Mailing Address - Country:US
Mailing Address - Phone:704-365-6675
Mailing Address - Fax:704-362-4119
Practice Address - Street 1:8310 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6701
Practice Address - Country:US
Practice Address - Phone:704-503-1800
Practice Address - Fax:704-503-4083
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice