Provider Demographics
NPI:1225204837
Name:BULOT, DAVID (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BULOT
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MONCLA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-2314
Mailing Address - Country:US
Mailing Address - Phone:504-208-1287
Mailing Address - Fax:
Practice Address - Street 1:411 MONCLA AVE
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-2314
Practice Address - Country:US
Practice Address - Phone:504-208-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-03
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery