| Advanced Dental Of Woolwich | |
|
1630 Rt 322 Suite F Woolwich NJ 08085 | |
| (856) 832-4480 | |
| Not Available |
| Full Name | Advanced Dental Of Woolwich |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1630 Rt 322, Woolwich, New Jersey |
| Authorized Official Name and Position | Laderrick Bullock (OWNER) |
| Authorized Official Contact | 8568324480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Dental Of Woolwich 1630 Rt 322 Suite F Woolwich NJ 08085 Ph: (856) 832-4480 | Advanced Dental Of Woolwich 1630 Rt 322 Suite F Woolwich NJ 08085 Ph: (856) 832-4480 |
| NPI Number | 1144595356 |
|---|---|
| Provider Enumeration Date | 03/21/2012 |
| Last Update Date | 03/21/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144595356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | 22DIO2196800 (New Jersey) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | 22DIO2146400 (New Jersey) | Primary |