Organization
ADVANCED DENTAL OF WOOLWICH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LADERRICK BULLOCK (OWNER)
(856) 832-4480
Entity
Organization
Contact information
Practice address
1630 RT 322, SUITE F, WOOLWICH, NJ 08085
(856) 832-4480
Mailing address
1630 RT 322, SUITE F, WOOLWICH, NJ 08085
(856) 832-4480
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
22DIO2146400
NJ
1223P0700X
Prosthodontics
22DIO2196800
NJ
Other
Enumeration date
03/21/2012
Last updated
03/21/2012
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