Provider Demographics
NPI:1336379684
Name:BOCK, BROOKE ELIZABETH (RDH)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:BOCK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 E LEAGUE CITY PKWY
Mailing Address - Street 2:STE 108
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3368
Mailing Address - Country:US
Mailing Address - Phone:281-334-5109
Mailing Address - Fax:
Practice Address - Street 1:2640 E LEAGUE CITY PKWY
Practice Address - Street 2:STE 108
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3368
Practice Address - Country:US
Practice Address - Phone:281-334-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14728124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist