NPIMap

Organization Active NPI

Blake M. Bullard, D.D.S., P.L.L.C.

Doing business as Bullard Dental

  • Dentist
  • Durant, OK
National Provider Identifier
1770993180
Registry record updated Jul 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6022 Issued in OK
Legal business name
BLAKE M. BULLARD, D.D.S., P.L.L.C.
Doing business as
Bullard Dental
Practice address
5008 W. University Blvd.
Durant, OK 74701-2978
Phone
(580) 931-3366
Fax
(580) 931-3390
NPI assigned
May 7, 2014
Last updated
Jul 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Blake Michael Bullard, D.D.S.NPI 1548421852
Title
Owner
Phone
(580) 931-3366

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 6022 OK Primary

Addresses

Primary practice location

5008 W. University Blvd.
Durant, OK 74701-2978

Mailing address

5008 W. University Blvd.
Durant, OK 74701-2978
Phone (580) 931-3366

Other names 1

  • Bullard Dental Doing business as

National Provider Directory

National Provider Directory

Locations

5008 W University Blvd
Durant, OK 74701
Phone (580) 931-3366

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1399420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530835200000",
    "number": "1770993180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5008 W. UNIVERSITY BLVD.",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747012978",
            "telephone_number": "580-931-3366",
            "fax_number": "580-931-3390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5008 W. UNIVERSITY BLVD.",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747012978",
            "telephone_number": "580-931-3366",
            "fax_number": "580-931-3390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKE M. BULLARD, D.D.S., P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-07",
        "last_updated": "2018-07-06",
        "status": "A",
        "authorized_official_last_name": "BULLARD",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-931-3366",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OK",
            "license": "6022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bullard Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bullard Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Durant, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2018; 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.