Provider Demographics
NPI:1669668935
Name:BULGERIN, TIMOTHY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:BULGERIN
Suffix:
Gender:M
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:PO BOX 853
Mailing Address - Street 2:115 EAST ST SUITE B
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634
Mailing Address - Country:US
Mailing Address - Phone:512-846-2468
Mailing Address - Fax:512-846-2904
Practice Address - Street 1:115 EAST ST
Practice Address - Street 2:SUITE B
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634
Practice Address - Country:US
Practice Address - Phone:512-846-2468
Practice Address - Fax:512-846-2904
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163201223E0200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics