Provider Demographics
NPI:1376622530
Name:QUOCK, WINTON J (DMD)
Entity Type:Individual
Prefix:DR
First Name:WINTON
Middle Name:J
Last Name:QUOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 GELLERT BOULEVARD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015
Mailing Address - Country:US
Mailing Address - Phone:650-756-4555
Mailing Address - Fax:650-756-4557
Practice Address - Street 1:333 GELLERT BOULEVARD
Practice Address - Street 2:SUITE 225
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:650-756-4555
Practice Address - Fax:650-756-4557
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA328911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics