Provider Demographics
NPI:1144570003
Name:BOCK AND HUTCHINSON, PLLC
Entity Type:Organization
Organization Name:BOCK AND HUTCHINSON, PLLC
Other - Org Name:SOUTH KITSAP FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-876-6211
Mailing Address - Street 1:1953 POTTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2558
Mailing Address - Country:US
Mailing Address - Phone:360-876-6211
Mailing Address - Fax:360-876-7952
Practice Address - Street 1:1953 POTTERY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2558
Practice Address - Country:US
Practice Address - Phone:360-876-6211
Practice Address - Fax:360-876-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA90391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA12230000XMedicaid