Provider Demographics
NPI:1518717917
Name:MOCKLER DENTAL CORP
Entity Type:Organization
Organization Name:MOCKLER DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:MOCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-886-8694
Mailing Address - Street 1:1875 S BASCOM AVE STE 2400
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2356
Mailing Address - Country:US
Mailing Address - Phone:408-886-8694
Mailing Address - Fax:
Practice Address - Street 1:281 E HAMILTON AVE STE 3
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0232
Practice Address - Country:US
Practice Address - Phone:408-871-0877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty