Provider Demographics
NPI:1235237330
Name:MOCK, ANTHONY GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GLENN
Last Name:MOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2147
Mailing Address - Country:US
Mailing Address - Phone:510-489-6900
Mailing Address - Fax:510-324-1759
Practice Address - Street 1:2701 DECOTO RD
Practice Address - Street 2:SUITE 1
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4940
Practice Address - Country:US
Practice Address - Phone:510-489-6900
Practice Address - Fax:510-324-1759
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist