Provider Demographics
NPI:1376612812
Name:CHOCK, CYNTHIA JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JEAN
Last Name:CHOCK
Suffix:
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 1:2060 E AVENIDA DE LOS ARBOLES
Mailing Address - Street 2:SUITE G
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1361
Mailing Address - Country:US
Mailing Address - Phone:805-493-2879
Mailing Address - Fax:805-241-1050
Practice Address - Street 1:2060 E AVENIDA DE LOS ARBOLES
Practice Address - Street 2:SUITE G
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-1361
Practice Address - Country:US
Practice Address - Phone:805-493-2879
Practice Address - Fax:805-241-1050
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice