NPIMap

Organization Active NPI

South Jersey Center for Advanced Dentistry, LLC

Doing business as SJ Center for Advanced Dentistry

  • Prosthodontics
  • Marlton, NJ
National Provider Identifier
1760006209
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
Legal business name
SOUTH JERSEY CENTER FOR ADVANCED DENTISTRY, LLC
Doing business as
SJ Center for Advanced Dentistry
Practice address
750 Route 73 S Ste 209
Marlton, NJ 08053-4133
Phone
(856) 988-7773
NPI assigned
Jun 1, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Authorized official

Name
Dr. Laderrick Bullock, DMDNPI 1386864353
Title
Owner
Phone
(856) 988-7773

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ProsthodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0700X Primary

Addresses

Primary practice location

750 Route 73 S Ste 209
Marlton, NJ 08053-4133

Mailing address

20 Box Turtle LN
Sicklerville, NJ 08081-5682
Phone (973) 202-0266

Other names 1

  • SJ Center for Advanced Dentistry Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@marltondentist.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1590969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1760006209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 BOX TURTLE LN",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080815682",
            "telephone_number": "973-202-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 ROUTE 73 S STE 209",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534133",
            "telephone_number": "856-988-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH JERSEY CENTER FOR ADVANCED DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-01",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "LADERRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-988-7773",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@marltondentist.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "MARLTON",
            "address_1": "750 Route 73 S Ste 209",
            "city": "Marlton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080534133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "SJ Center for Advanced Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marlton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2020; 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.