Provider Demographics
NPI:1114309374
Name:BULLOCK, PETER J (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 EDGEMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951
Mailing Address - Country:US
Mailing Address - Phone:215-536-1717
Mailing Address - Fax:215-529-9809
Practice Address - Street 1:355 EDGEMONT AVENUE
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951
Practice Address - Country:US
Practice Address - Phone:215-536-1717
Practice Address - Fax:215-529-9809
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist