Provider Demographics
NPI:1821208679
Name:GOCK, LORRAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:GOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7014
Mailing Address - Country:US
Mailing Address - Phone:707-546-9882
Mailing Address - Fax:707-546-9886
Practice Address - Street 1:3910 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7014
Practice Address - Country:US
Practice Address - Phone:707-546-9882
Practice Address - Fax:707-546-9886
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice