Scott Edwin Bulloch, DDS MS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

2735969224 Issued in UT

Practice address

754 S Main St
Suite 5
St George, UT 84770

Phone

(435) 652-1445

Fax

(435) 652-0138

NPI assigned

Oct 26, 2007

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

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193356800000",
    "number": "1821277872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "754 S MAIN ST",
            "address_2": "SUITE 5",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "84770",
            "telephone_number": "435-652-1445",
            "fax_number": "435-652-0138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "754 S MAIN ST",
            "address_2": "SUITE 5",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "84770",
            "telephone_number": "435-652-1445",
            "fax_number": "435-652-0138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCH",
        "first_name": "SCOTT",
        "middle_name": "EDWIN",
        "credential": "DDS MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-26",
        "last_updated": "2007-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "UT",
            "license": "2735969224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candy Buenrostro
• Traci Buff
• Gracy Buffington
• Matt Bulkley, LCSW
• Brett Wallace Bulloch, CRNA
• Alexander Bullock
• Maxine Bumgardner
• Cody Kirt Bunker
• Kasen Ray Buoy
• Dustin Lee Burbank, PA-C

• Oral & Maxillofacial Surgery (D.M.D.) in St George, UT
• Providers in St George, UT by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.