Precision Implant & Oral Surgery PC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

273596-9924 Issued in UT

Legal business name

PRECISION IMPLANT & ORAL SURGERY PC

Doing business as

Scott E Bulloch DDS, MS

Practice address

754 S Main St
Suite 5
St George, UT 84770-5504

Phone

(435) 652-1445

Fax

(435) 652-0138

NPI assigned

Jul 26, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Scott Edwin Bulloch, DDS, MS

Title

President

Phone

(435) 652-1445

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Scott E Bulloch DDS, MS Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507766400000",
    "number": "1164422739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "754 S MAIN ST",
            "address_2": "SUITE 5",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847705504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "754 S MAIN ST",
            "address_2": "SUITE 5",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847705504",
            "telephone_number": "435-652-1445",
            "fax_number": "435-652-0138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRECISION IMPLANT & ORAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2017-10-12",
        "status": "A",
        "authorized_official_last_name": "BULLOCH",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "435-652-1445",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "UT",
            "license": "273596-9924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "562454357012",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Scott E Bulloch DDS, MS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oral & Maxillofacial Surgery (D.M.D.) in St George, UT
• Providers in St George, UT by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.