Provider Demographics
NPI:1942641717
Name:BULLEIGH, NATHAN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:T
Last Name:BULLEIGH
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 1:310 S OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:OK
Mailing Address - Zip Code:74029-2742
Mailing Address - Country:US
Mailing Address - Phone:918-534-3170
Mailing Address - Fax:
Practice Address - Street 1:310 S OSAGE AVE
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:OK
Practice Address - Zip Code:74029-2742
Practice Address - Country:US
Practice Address - Phone:918-534-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist