Individual
DR. ALYSHA BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
1090 MERIDEN WATERBURY TPKE, CHESHIRE, CT 06410-7130
(203) 272-8222
(203) 272-8270
Mailing address
6 KING ARTHUR WAY, APARTMENT 6, NEWINGTON, CT 06111-2209
(203) 278-9393
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11659
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004011136
—
CT
Enumeration date
06/18/2015
Last updated
07/11/2016
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