Active NPI
Jon Buford Dull, DDS
- Dentist
- Muncie, IN
National Provider Identifier
1720136468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12008566A
- Practice address
- 1812 W McGalliard Rd
Muncie, IN 47304-2209 - Phone
- (765) 282-7320
- NPI assigned
- Jan 8, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 12008566A | IN | Primary |
Addresses
Primary practice location
1812 W McGalliard Rd
Muncie, IN 47304-2209
Mailing address
1812 W McGalliard Rd
Muncie, IN 47304-2209
Phone (765) 282-7320
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12008566A | Other | IN | DENTAL LICENSE |
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 |
|---|---|---|---|
| 12008566A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720136468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1812 W MCGALLIARD RD",
"city": "MUNCIE",
"state": "IN",
"postal_code": "473042209",
"telephone_number": "765-282-7320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1812 W MCGALLIARD RD",
"city": "MUNCIE",
"state": "IN",
"postal_code": "473042209",
"telephone_number": "765-282-7320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DULL",
"first_name": "JON",
"middle_name": "BUFORD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12008566A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "12008566A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Muncie, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.