Provider Demographics
NPI:1710325451
Name:GARCIA BULLARD, IRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:
Last Name:GARCIA BULLARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:IRIS
Other - Middle Name:C
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1857 CANMONT DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3617
Mailing Address - Country:US
Mailing Address - Phone:904-742-5507
Mailing Address - Fax:
Practice Address - Street 1:3167 PEACHTREE RD NE STE A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1812
Practice Address - Country:US
Practice Address - Phone:678-941-5435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20114122300000X
GADN015820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist