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Individual

DR. CHARLIE BULLER III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
206 THOMPSON AVE., IOWA, LA 70647
(337) 582-7225
(337) 582-4867
Mailing address
PO BOX 1179, IOWA, LA 70647-1179
(337) 582-7225
(337) 582-4867

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4022
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1840220
LA
Enumeration date
02/23/2007
Last updated
07/08/2007
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