Individual
CAL THOMAS BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
LL633
MD
122300000X
Dentist
LL674
MD
1223P0221X
Pediatric Dentistry
Primary
DEN-DEN-LIC-7748
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119591300
—
MD
Enumeration date
07/13/2012
Last updated
06/07/2017
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