Provider Demographics
NPI:1851301824
Name:BULARD, RONALD ALAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ALAN
Last Name:BULARD
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 1:2401 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1280
Mailing Address - Country:US
Mailing Address - Phone:580-226-0410
Mailing Address - Fax:580-224-9124
Practice Address - Street 1:2401 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1280
Practice Address - Country:US
Practice Address - Phone:580-226-0410
Practice Address - Fax:580-224-9124
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046651OtherNEW YORK LICENSE
OK891528OtherUNITED CONCORDIA NUMBER
OK4684OtherOKLAHOMA LICENSE
OKU-57618Medicare ID - Type Unspecified