Provider Demographics
NPI:1720078058
Name:BULL, JOHN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:BULL
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 1:2226 DOGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8402
Mailing Address - Country:US
Mailing Address - Phone:970-243-2855
Mailing Address - Fax:970-256-9467
Practice Address - Street 1:2226 DOGWOOD CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8402
Practice Address - Country:US
Practice Address - Phone:970-242-3362
Practice Address - Fax:970-256-9467
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01671223P0221X
CO00000167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13720112Medicaid
CO28800079Medicaid
CO02001675Medicaid