Provider Demographics
NPI:1841385887
Name:ZOCH, FRED FRANKLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:FRANKLIN
Last Name:ZOCH
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 1:2525 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-2847
Mailing Address - Country:US
Mailing Address - Phone:409-735-7108
Mailing Address - Fax:409-735-6596
Practice Address - Street 1:2525 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-2847
Practice Address - Country:US
Practice Address - Phone:409-735-7108
Practice Address - Fax:409-735-6596
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15955OtherSTATE LINCENSE