Provider Demographics
NPI:1770050296
Name:BULLOCK, DENNIS MCCRAY (CERTIFIDE SURGICAL A)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:MCCRAY
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:CERTIFIDE SURGICAL A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 FORT DAVIS TRL
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-3556
Mailing Address - Country:US
Mailing Address - Phone:443-532-5784
Mailing Address - Fax:
Practice Address - Street 1:1083 FORT DAVIS TRL
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-3556
Practice Address - Country:US
Practice Address - Phone:410-326-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA0051207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery