Provider Demographics
NPI:1922791250
Name:BOCKRATH, EMMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:
Last Name:BOCKRATH
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 1:3811 GRAND OAK TRL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-5011
Mailing Address - Country:US
Mailing Address - Phone:937-474-3130
Mailing Address - Fax:
Practice Address - Street 1:4353 OH-73
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068
Practice Address - Country:US
Practice Address - Phone:513-897-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002055661223G0001X
OH30.027148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice