Ryan Newell Bullen, DMD, DHSC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

8693 Issued in AZ

Practice address

1845 McCulloch Blvd N Ste A1
Lake Havasu City, AZ 86403-5722

Phone

(928) 855-7700

NPI assigned

Sep 5, 2013

Sex

Male

Sole proprietor

Yes

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arizona Dental Sleep Therapy

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Lake Havasu City, AZ
  • NPI 1760773907
  NPD (past)

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

{
    "created_epoch": "1378339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378339200000",
    "number": "1457786741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 W BELLO VISTA PLZ",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864092975",
            "telephone_number": "801-787-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1845 MCCULLOCH BLVD N STE A1",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035722",
            "telephone_number": "928-855-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLEN",
        "first_name": "RYAN",
        "middle_name": "NEWELL",
        "name_prefix": "Dr.",
        "credential": "DMD, DHSC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-09-05",
        "last_updated": "2013-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AZ",
            "license": "8693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Marie Bronni, M.D.
• Brookeside LLC
• Pamela Robin Brookman
• Jackson Thomas Lee Buckman, OD
• Buena Suerte, Inc.
• Rhett Melvin Burgener, OD
• Derek M Burnett, MD
• Lynn Marie Burns, RN
• Jeremy Burress
• Burt Faibisoff, MD, PLLC

• Orthodontics and Dentofacial Orthopedics Dentistry in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; 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.