Active NPI
Mitchel Bulger
- Dentist
- Killeen, TX
National Provider Identifier
1376231324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 39522
- Practice address
- 4102 Clear Creek Rd Ste 102
Killeen, TX 76549-5954 - Phone
- (810) 706-0679
- NPI assigned
- Apr 27, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 39522 | TX | Primary |
Addresses
Primary practice location
4102 Clear Creek Rd Ste 102
Killeen, TX 76549-5954
Mailing address
316 N 35TH St Apt 20
Omaha, NE 68131-2426
Phone (810) 706-0679
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39522 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690156800000",
"number": "1376231324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "316 N 35TH ST APT 20",
"city": "OMAHA",
"state": "NE",
"postal_code": "681312426",
"telephone_number": "810-706-0679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4102 CLEAR CREEK RD STE 102",
"city": "KILLEEN",
"state": "TX",
"postal_code": "765495954",
"telephone_number": "810-706-0679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULGER",
"first_name": "MITCHEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-04-27",
"last_updated": "2023-07-24",
"certification_date": "2023-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "39522",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Killeen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.