Provider Demographics
NPI:1770864696
Name:BULSARA, DILBER (BDS MPH)
Entity Type:Individual
Prefix:DR
First Name:DILBER
Middle Name:
Last Name:BULSARA
Suffix:
Gender:F
Credentials:BDS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 CAT CLAW CV
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5548
Mailing Address - Country:US
Mailing Address - Phone:512-694-4187
Mailing Address - Fax:
Practice Address - Street 1:11100 PARKFIELD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4263
Practice Address - Country:US
Practice Address - Phone:512-339-7848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX263271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice