Dr. Russell Bullen, DMD
Dentist in Pueblo, CO. Individual provider (NPI-1).
NPI number1639512015
StatusActive
Last updated in NPPESDec 3, 2019
Details
- NPI
- 1639512015
- Entity type
- Individual (NPI-1)
- Name
- Dr. Russell Bullen
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 16, 2013
- Last updated
- Dec 3, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 00203038 | CO | Yes |
| 1223G0001X | Dentist, General Practice | 00203038 | CO | |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
1221 S Pueblo BlvdPueblo, CO 81005-1507
Phone 801-427-6715
Mailing address
1221 S Pueblo BlvdPueblo, CO 81005-1507
Phone 801-427-6715
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