Active NPI
Russell Bullen, DMD
- Dentist
- Pueblo, CO
National Provider Identifier
1639512015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 00203038
- Practice address
- 1221 S Pueblo Blvd
Pueblo, CO 81005-1507 - Phone
- (801) 427-6715
- NPI assigned
- Apr 16, 2013
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 00203038 | CO | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 00203038 | CO | Primary |
Addresses
Primary practice location
1221 S Pueblo Blvd
Pueblo, CO 81005-1507
Mailing address
1221 S Pueblo Blvd
Pueblo, CO 81005-1507
Phone (801) 427-6715
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 |
|---|---|---|---|
| 00203038 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575331200000",
"number": "1639512015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 S PUEBLO BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810051507",
"telephone_number": "801-427-6715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 S PUEBLO BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810051507",
"telephone_number": "801-427-6715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLEN",
"first_name": "RUSSELL",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-04-16",
"last_updated": "2019-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "00203038",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "00203038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.