Individual
DR. RUSSELL BULLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1221 S PUEBLO BLVD, PUEBLO, CO 81005-1507
(801) 427-6715
Mailing address
1221 S PUEBLO BLVD, PUEBLO, CO 81005-1507
(801) 427-6715
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
00203038
CO
1223G0001X
General Practice Dentistry
00203038
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2013
Last updated
12/03/2019
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