Provider Demographics
NPI:1477835270
Name:BOCASH, GREGORY WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WILLIAM
Last Name:BOCASH
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 1:50 LORI LN
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1231
Mailing Address - Country:US
Mailing Address - Phone:805-573-9508
Mailing Address - Fax:
Practice Address - Street 1:18285 COLLIER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2786
Practice Address - Country:US
Practice Address - Phone:951-471-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA605731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice