Provider Demographics
NPI:1508983909
Name:BULL -LIGON, MENDEE V (DDS)
Entity Type:Individual
Prefix:DR
First Name:MENDEE
Middle Name:V
Last Name:BULL -LIGON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8141
Mailing Address - Country:US
Mailing Address - Phone:727-321-7880
Mailing Address - Fax:727-327-6484
Practice Address - Street 1:5201 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8141
Practice Address - Country:US
Practice Address - Phone:727-321-7880
Practice Address - Fax:727-327-6484
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL87201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice