Active NPI
David W Bull, DENTIST
- General Practice Dentistry
- Polson, MT
National Provider Identifier
1376609586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DEN-DEN-LIC-1764
- Practice address
- 5 4TH Ave E
Polson, MT 59860-2117 - Phone
- (406) 745-3525
- NPI assigned
- Dec 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DEN-DEN-LIC-1764 | MT | Primary |
Addresses
Primary practice location
5 4TH Ave E
Polson, MT 59860-2117
Mailing address
PO Box 880
Saint Ignatius, MT 59865-0880
Phone (406) 745-3525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150714001754 | MT | Order and Referring Only - Dentist | 6608189006 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710460800000",
"number": "1376609586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 880",
"city": "SAINT IGNATIUS",
"state": "MT",
"postal_code": "598650880",
"telephone_number": "406-745-3525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 4TH AVE E",
"city": "POLSON",
"state": "MT",
"postal_code": "598602117",
"telephone_number": "406-745-3525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULL",
"first_name": "DAVID",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "DENTIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-29",
"last_updated": "2024-03-15",
"certification_date": "2024-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MT",
"license": "DEN-DEN-LIC-1764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Polson, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.