Provider Demographics
NPI:1265706527
Name:W.L. BULLIS, D.D.S.,P.C.
Entity type:Organization
Organization Name:W.L. BULLIS, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.C.
Authorized Official - Prefix:
Authorized Official - First Name:W.
Authorized Official - Middle Name:L
Authorized Official - Last Name:BULLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-359-0371
Mailing Address - Street 1:3409 S GEORGIA ST
Mailing Address - Street 2:STE 12
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4844
Mailing Address - Country:US
Mailing Address - Phone:806-359-0371
Mailing Address - Fax:806-463-5205
Practice Address - Street 1:3409 S GEORGIA ST
Practice Address - Street 2:STE 12
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4844
Practice Address - Country:US
Practice Address - Phone:806-359-0371
Practice Address - Fax:806-463-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX084041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty