Provider Demographics
NPI:1376044909
Name:PETER L BULTHUIS DDS PC
Entity Type:Organization
Organization Name:PETER L BULTHUIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BULTHUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-422-1332
Mailing Address - Street 1:5625 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2457
Mailing Address - Country:US
Mailing Address - Phone:734-422-1332
Mailing Address - Fax:734-422-1335
Practice Address - Street 1:5625 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2457
Practice Address - Country:US
Practice Address - Phone:734-422-1332
Practice Address - Fax:734-422-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI132461223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty