Provider Demographics
NPI:1770114159
Name:BROOKE H. BULLER, DDS, LLC
Entity type:Organization
Organization Name:BROOKE H. BULLER, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-289-9099
Mailing Address - Street 1:325 E GATES ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-3627
Mailing Address - Country:US
Mailing Address - Phone:330-289-9099
Mailing Address - Fax:
Practice Address - Street 1:255 LINCOLN CIR STE B
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3514
Practice Address - Country:US
Practice Address - Phone:614-475-1874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental