Individual
JERI LYNN BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1144 E FORT UNION BLVD, MIDVALE, UT 84047-1804
(801) 566-3118
Mailing address
1144 E FORT UNION BLVD, MIDVALE, UT 84047-1804
(801) 566-3118
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401414490
VA
1223G0001X
General Practice Dentistry
016.0078267
VT
1223G0001X
General Practice Dentistry
Primary
90-0809888
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019260
—
VT
Enumeration date
06/10/2011
Last updated
07/21/2022
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