Organization Name: | BULL MOUNTAIN FAMILY DENTISTRY, PC |
NPI Number: | 1285919555 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NIRVANA SCHUYLER (DENTIST/PRESIDENT) |
Mailing Address: | 15885 Sw 116th Ave King City |
State: | OR US |
Postal Code: | 972242647 |
Phone Number: | 5039017345 |
Fax Number: | |
NPI Enumeration Date: | 10/18/2011 |
NPI Last Update Date: | 10/18/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | D8974 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |