Provider Demographics
NPI:1811066632
Name:BULLARD, RICHARD L (DDS PA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:BULLARD
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622NMAIN
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033
Mailing Address - Country:US
Mailing Address - Phone:817-517-7557
Mailing Address - Fax:817-641-2779
Practice Address - Street 1:622 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-3842
Practice Address - Country:US
Practice Address - Phone:817-517-7557
Practice Address - Fax:817-624-1126
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174186014Medicaid
TX21787OtherDENTAL LICENSE