Provider Demographics
NPI:1861495905
Name:BULLARD, DENNIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:E
Last Name:BULLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 SUNDAY DR
Mailing Address - Street 2:STE 214
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6000
Mailing Address - Country:US
Mailing Address - Phone:919-235-0222
Mailing Address - Fax:919-235-0227
Practice Address - Street 1:1540 SUNDAY DR
Practice Address - Street 2:STE 214
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6000
Practice Address - Country:US
Practice Address - Phone:919-235-0222
Practice Address - Fax:919-235-0227
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8919702Medicaid
NC8919702Medicaid
NCC83043Medicare UPIN