Dr. Luther B Bullock Jr., D.D.S.
Dentist in Salem, OR. Individual provider (NPI-1).
NPI number1063584530
StatusActive
Last updated in NPPESJan 12, 2012
Details
- NPI
- 1063584530
- Entity type
- Individual (NPI-1)
- Name
- Dr. Luther B Bullock Jr.
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 13, 2006
- Last updated
- Jan 12, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | D8385 | OR | Yes |
Practice location
3694 Bayonne Dr.Salem, OR 97317-5393
Phone 503-689-1838
Mailing address
3694 Bayonne Dr.Salem, OR 97317-5393
Phone 503-689-1838
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