Provider Demographics
NPI:1114023462
Name:MOCK, ERICH STEPHEN I (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERICH
Middle Name:STEPHEN
Last Name:MOCK
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ERICH
Other - Middle Name:STEPHEN
Other - Last Name:MOCK
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:22627 NE 150TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077
Mailing Address - Country:US
Mailing Address - Phone:425-844-2171
Mailing Address - Fax:
Practice Address - Street 1:12817 120TH AVE NE,
Practice Address - Street 2:SUITE B
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-821-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA74251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice