Provider Demographics
NPI:1689762437
Name:KOCKRITZ, JEFFREY NEAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NEAL
Last Name:KOCKRITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 W MAIN ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4234
Mailing Address - Country:US
Mailing Address - Phone:360-687-4721
Mailing Address - Fax:360-666-1600
Practice Address - Street 1:1215 SW SCOTTON WAY
Practice Address - Street 2:SUITE 121
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9860
Practice Address - Country:US
Practice Address - Phone:360-687-4721
Practice Address - Fax:360-342-8909
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI74261223G0001X
WA74261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice