Active NPI
Brett Bullard
- General Practice Dentistry
- Northville, MI
National Provider Identifier
1982011771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2901021367
- Practice address
- 20075 Northville Place Dr Apt 3122
Northville, MI 48167-2962 - Phone
- (810) 577-8916
- NPI assigned
- Jul 14, 2014
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901021367 | MI | Primary |
Addresses
Primary practice location
20075 Northville Place Dr Apt 3122
Northville, MI 48167-2962
Mailing address
20075 Northville Place Dr Apt 3122
Northville, MI 48167-2962
Phone (810) 577-8916
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 |
|---|---|---|---|
| 2901021367 | MI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405296000000",
"number": "1982011771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20075 NORTHVILLE PLACE DR APT 3122",
"city": "NORTHVILLE",
"state": "MI",
"postal_code": "481672962",
"telephone_number": "810-577-8916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20075 NORTHVILLE PLACE DR APT 3122",
"city": "NORTHVILLE",
"state": "MI",
"postal_code": "481672962",
"telephone_number": "810-577-8916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLARD",
"first_name": "BRETT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-14",
"last_updated": "2014-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901021367",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.