Provider Demographics
NPI:1356675920
Name:POCOCK, ANDREW LUKE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LUKE
Last Name:POCOCK
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 1:241 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6139
Mailing Address - Country:US
Mailing Address - Phone:303-808-3489
Mailing Address - Fax:208-733-2690
Practice Address - Street 1:241 4TH AVE N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6139
Practice Address - Country:US
Practice Address - Phone:303-808-3489
Practice Address - Fax:208-733-2690
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice