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General NPI Number Information
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NPI Number | 1386864353
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Entity Type | Individual
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Provider Name | LADERRICK BULLOCK D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1793 SPRINGDALE RD
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2136
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Country | US
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Telephone | 856-424-7177
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Fax |
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Provider Business Mailing Address
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Address Line | 20 BOX TURTLE LN
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-5682
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 22DI02196800
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License Number State | NJ
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