Provider Demographics
NPI:1659832475
Name:NOCHEZ, GRACE BERNHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:BERNHARD
Last Name:NOCHEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:M
Other - Last Name:BERNHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5710 N DAVIS HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2039
Mailing Address - Country:US
Mailing Address - Phone:850-391-3313
Mailing Address - Fax:
Practice Address - Street 1:5710 N DAVIS HWY STE 1
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2039
Practice Address - Country:US
Practice Address - Phone:850-391-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6991122300000X
FL242121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist