Provider Demographics
NPI:1710005079
Name:BULVERDE ORTHODONTICS PA
Entity Type:Organization
Organization Name:BULVERDE ORTHODONTICS PA
Other - Org Name:FERRIS ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:WHITMAN
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:830-438-7250
Mailing Address - Street 1:24165 W INTERSTATE 10 STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1160
Mailing Address - Country:US
Mailing Address - Phone:210-698-2480
Mailing Address - Fax:210-698-3595
Practice Address - Street 1:172 CREEKSIDE PARK RD STE 113
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6238
Practice Address - Country:US
Practice Address - Phone:830-438-7250
Practice Address - Fax:830-438-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN