Provider Demographics
NPI:1497183800
Name:JULIET SUZANNE BULNES DMD, PA
Entity Type:Organization
Organization Name:JULIET SUZANNE BULNES DMD, PA
Other - Org Name:WESTCHASE ESTHETIC FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-792-8211
Mailing Address - Street 1:10810 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5117
Mailing Address - Country:US
Mailing Address - Phone:813-792-8211
Mailing Address - Fax:813-792-9722
Practice Address - Street 1:10810 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-5117
Practice Address - Country:US
Practice Address - Phone:813-792-8211
Practice Address - Fax:813-792-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15808261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental