Individual
BLAKE M. BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5008 W. UNIVERSITY BLVD., DURANT, OK 74701
(580) 931-3366
(580) 931-3390
Mailing address
5008 W. UNIVERSITY BLVD., DURANT, OK 74701
(580) 931-3366
(580) 931-3390
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6022
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200203570A
—
OK
Enumeration date
06/19/2008
Last updated
06/20/2018
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