| NPI | 1144595356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LADERRICK BULLOCK Owner 856-832-4480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DIO2146400) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DIO2196800) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2012-03-21 |