Provider Demographics
NPI:1083747729
Name:TRUSCINSKI & KOCKRITZ DDS
Entity Type:Organization
Organization Name:TRUSCINSKI & KOCKRITZ DDS
Other - Org Name:BATTLE GROUND DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:TRUSCINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-687-4721
Mailing Address - Street 1:2312 WEST MAIN STREET
Mailing Address - Street 2:SUITE 121
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4233
Mailing Address - Country:US
Mailing Address - Phone:360-687-4721
Mailing Address - Fax:360-666-1600
Practice Address - Street 1:2312 WEST MAIN STREET
Practice Address - Street 2:SUITE 121
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4233
Practice Address - Country:US
Practice Address - Phone:360-687-4721
Practice Address - Fax:360-666-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA07426122300000X
WA065651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty