Provider Demographics
NPI:1265697585
Name:BOCKUS, MARIE DANELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:DANELLE
Last Name:BOCKUS
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 1:1025 E VANDAMENT AVE
Mailing Address - Street 2:#300
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4910
Mailing Address - Country:US
Mailing Address - Phone:405-354-1861
Mailing Address - Fax:
Practice Address - Street 1:1025 E VANDAMENT AVE
Practice Address - Street 2:#300
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4910
Practice Address - Country:US
Practice Address - Phone:405-354-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice