Provider Demographics
NPI:1336505015
Name:TROCKEL, MARTIN FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:FREDERICK
Last Name:TROCKEL
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 1:12345 S MEMORIAL DR
Mailing Address - Street 2:STE 113
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2569
Mailing Address - Country:US
Mailing Address - Phone:918-364-2222
Mailing Address - Fax:
Practice Address - Street 1:12345 S MEMORIAL DR
Practice Address - Street 2:STE 113
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2569
Practice Address - Country:US
Practice Address - Phone:918-364-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK67171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice