Provider Demographics
NPI:1568686178
Name:MOCKAITIS, REED PATRICK (DDS, MS, PA)
Entity Type:Individual
Prefix:DR
First Name:REED
Middle Name:PATRICK
Last Name:MOCKAITIS
Suffix:
Gender:M
Credentials:DDS, MS, PA
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Mailing Address - Street 1:417 W WARREN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5329
Mailing Address - Country:US
Mailing Address - Phone:704-487-9399
Mailing Address - Fax:704-487-9388
Practice Address - Street 1:417 W WARREN ST
Practice Address - Street 2:SUITE B
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5329
Practice Address - Country:US
Practice Address - Phone:704-487-9399
Practice Address - Fax:704-487-9388
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC76401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics