Provider Demographics
NPI:1457522971
Name:BULLARD, SAM (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:BULLARD
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:9240 N MERIDIAN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1880
Mailing Address - Country:US
Mailing Address - Phone:317-580-9199
Mailing Address - Fax:317-580-6746
Practice Address - Street 1:9240 N MERIDIAN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1880
Practice Address - Country:US
Practice Address - Phone:317-580-9199
Practice Address - Fax:317-580-6746
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010489A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry