Provider Demographics
NPI:1780868471
Name:MOCK, WILBUR DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILBUR
Middle Name:DEAN
Last Name:MOCK
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 1:5000 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1964
Mailing Address - Country:US
Mailing Address - Phone:509-783-5000
Mailing Address - Fax:509-783-8349
Practice Address - Street 1:5000 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1964
Practice Address - Country:US
Practice Address - Phone:509-783-5000
Practice Address - Fax:509-783-8349
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist