| Organization Name: | ADVANCED DENTAL OF WOOLWICH |
| NPI Number: | 1144595356 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LADERRICK BULLOCK (OWNER) |
| Mailing Address: | 1630 Rt 322 Suite F Woolwich |
| State: | NJ US |
| Postal Code: | 08085 |
| Phone Number: | 8568324480 |
| Fax Number: | |
| NPI Enumeration Date: | 03/21/2012 |
| NPI Last Update Date: | 03/21/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0700X |
| License Number: | 22DIO2196800 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Prosthodontics |
| Taxonomy Definition: | That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |