Richard L Bullard, DDS PA
Individual provider Active NPI Dentist · Cleburne, TX
NPI 1811066632 · NPPES record last updated Mar 14, 2017
Key facts
- NPI
- 1811066632
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 21787 (TX)
- Practice address
- 622 N Main St
Cleburne, TX 76033-3842 - Phone
- (817) 517-7557
- Fax
- (817) 624-1126
- NPI assigned
- Nov 7, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21787 | TX | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 21787 | TX | Yes |
Addresses
Primary practice location
622 N Main St
Cleburne, TX 76033-3842
Mailing address
622Nmain
Cleburne, TX 76033
Phone (817) 517-7557
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 174186014 | Medicaid | TX | |
| 21787 | Other | TX | DENTAL LICENSE |
Other providers in Cleburne, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.