# SOUTH JERSEY CENTER FOR ADVANCED DENTISTRY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SJ Center for Advanced Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760006209
- **Authorized official:** DR. LADERRICK BULLOCK DMD (OWNER)
- **Authorized official phone:** (856) 988-7773

## Contact information

- **Practice address:** 750 ROUTE 73 S STE 209, MARLTON, NJ 08053-4133
- **Practice address phone:** (856) 988-7773
- **Mailing address:** 20 BOX TURTLE LN, SICKLERVILLE, NJ 08081-5682
- **Mailing address phone:** (973) 202-0266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0700X | Prosthodontics | — | NULL | Yes |
| 1223P0700X | Prosthodontics | — | — | Yes |

## Other

- **Enumeration date:** 06/01/2020
- **Last updated:** 06/01/2020