Provider Demographics
NPI:1407282346
Name:BULLINGTON, BERT MONTELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:BERT
Middle Name:MONTELL
Last Name:BULLINGTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 W INGOMAR RD
Mailing Address - Street 2:P.O. BOX 35
Mailing Address - City:INGOMAR
Mailing Address - State:PA
Mailing Address - Zip Code:15127-2000
Mailing Address - Country:US
Mailing Address - Phone:412-364-7188
Mailing Address - Fax:412-348-0143
Practice Address - Street 1:736 W INGOMAR RD
Practice Address - Street 2:
Practice Address - City:INGOMAR
Practice Address - State:PA
Practice Address - Zip Code:15127-2000
Practice Address - Country:US
Practice Address - Phone:412-364-7188
Practice Address - Fax:412-348-0143
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016950L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS016950LOtherDENTAL LICENSE