Marlo Bulza, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11528 Issued in OR

Practice address

16679 Boones Ferry Rd Ste 215
Lake Oswego, OR 97035-4368

Phone

(503) 636-7601

Fax

(503) 636-3749

NPI assigned

Sep 7, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1630972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1295404986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 S CURRY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394753",
            "telephone_number": "971-404-5422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16679 BOONES FERRY RD STE 215",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354368",
            "telephone_number": "503-636-7601",
            "fax_number": "503-636-3749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULZA",
        "first_name": "MARLO",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-07",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wyatt James Brown, C.PED.
• Geraldine Ruth Brownstein, MS LCSW
• Desiree Renee Bryant, LMT
• Kelsie Bryant
• Brooke Nicole Buckland, PA-C
• Olga Burger
• Elisa A Burgess, MD
• Larry Thomas Burks, D.C.
• Malika Burman, M.D.
• Cheryl Kathryn Burris, APRN

• General Practice Dentistry in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; 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.