Jeri Lynn Bullock, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

90-0809888 Issued in UT

Practice address

1144 E Fort Union Blvd
Midvale, UT 84047-1804

Phone

(801) 566-3118

NPI assigned

Jun 10, 2011

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jbullock272351@direct.med.utah.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Midvale Modern Dentistry, LLP

  dba Midvale Modern Dentistry and Orthodontics

  • General Practice Dentistry
  • Midvale, UT
  • NPI 1407112469
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1396030003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1144 E FORT UNION BLVD",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840471804",
            "telephone_number": "801-566-3118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1144 E FORT UNION BLVD",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840471804",
            "telephone_number": "801-566-3118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "319 5th Ave",
            "address_purpose": "LOCATION",
            "city": "Saltville",
            "state": "VA",
            "postal_code": "243703418",
            "country_code": "US",
            "telephone_number": "276-496-4492 x5",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "JERI",
        "middle_name": "LYNN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-10",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401414490",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VT",
            "license": "016.0078267",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "90-0809888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019260",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sammy Brown
• Ellie Sue Brownstein, MD
• Emma Brudnicki
• Blanca V Buchanan, LSUDC
• Karen Ruth Buist, RN
• Gerrit Bursma, ASUDC
• Chad S Burt, DMD
• Lezli Burt, CSW
• Kennedy Bustamante
• Anni Butterfield, LCSW

• General Practice Dentistry in Midvale, UT
• Providers in Midvale, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.