Provider Demographics
NPI:1205921525
Name:MOCK, GREGORY D (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
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 1:559 E PIKES PEAK AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903
Mailing Address - Country:US
Mailing Address - Phone:719-473-9222
Mailing Address - Fax:719-473-0133
Practice Address - Street 1:559 E PIKES PEAK AVE
Practice Address - Street 2:STE 203
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-473-9222
Practice Address - Fax:719-473-0133
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1046461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice