Provider Demographics
NPI:1225605298
Name:BOCK, SALLY MARGARET X (DDS)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:MARGARET
Last Name:BOCK
Suffix:X
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 NE 2ND ST APT 113
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-2250
Mailing Address - Country:US
Mailing Address - Phone:405-821-0284
Mailing Address - Fax:
Practice Address - Street 1:561 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6575
Practice Address - Country:US
Practice Address - Phone:405-321-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice