Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 043928 | NY |
NPI | 1033149018 |
---|---|
Provider Name | Dr. Lionel Angelo Bulford |
First Address | Saratoga Springs, NY 12866-8624 |
Second Address | Saratoga Springs, NY 12866-8624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U71741 | (02) |