Advanced Dental of Woolwich

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

22DIO2146400 Issued in NJ

Legal business name

ADVANCED DENTAL OF WOOLWICH

Practice address

1630 RT 322
Suite F
Woolwich, NJ 08085

Phone

(856) 832-4480

NPI assigned

Mar 21, 2012

Organization subpart

No

Name

Dr. Laderrick BullockNPI 1386864353

Title

Owner

Phone

(856) 832-4480

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laderrick Bullock, D.M.D.

  • Prosthodontics
  • Cherry Hill, NJ
  • NPI 1386864353
  NPD Authorized official

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 21, 2012.

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1144595356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 RT 322",
            "address_2": "SUITE F",
            "city": "WOOLWICH",
            "state": "NJ",
            "postal_code": "08085",
            "telephone_number": "856-832-4480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 RT 322",
            "address_2": "SUITE F",
            "city": "WOOLWICH",
            "state": "NJ",
            "postal_code": "08085",
            "telephone_number": "856-832-4480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL OF WOOLWICH",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-21",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "LADERRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-832-4480",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DIO2146400",
            "primary": true
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "NJ",
            "license": "22DIO2196800",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan C Ferretta, PT
• Shine Center for Healing LLC
• Linda Marie Tucker-Simpson, MS,CCC-SLP

• All providers in Woolwich, NJ
• Pediatric Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.