| Charlie Buller Iii Dds | |
|
206 Thomson Ave. Iowa LA 70647-1179 | |
| (337) 582-7225 | |
| (337) 582-4867 |
| Full Name | Charlie Buller Iii Dds |
|---|---|
| Speciality | Dentist |
| Location | 206 Thomson Ave., Iowa, Louisiana |
| Authorized Official Name and Position | Charlie Buller (OWNER) |
| Authorized Official Contact | 3375827225 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Charlie Buller Iii Dds Po Box 1179 Iowa LA 70647-1179 Ph: (337) 582-7225 | Charlie Buller Iii Dds 206 Thomson Ave. Iowa LA 70647-1179 Ph: (337) 582-7225 |
| NPI Number | 1255629390 |
|---|---|
| Provider Enumeration Date | 07/11/2011 |
| Last Update Date | 07/11/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255629390 | NPI | - | NPPES |
| 1840220 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 6173 (Louisiana) | Secondary |
| 122300000X | Dentist | 4022 (Louisiana) | Primary |