Provider Demographics
NPI:1912988825
Name:DOCK, ANITA L (RD LD CDE)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:L
Last Name:DOCK
Suffix:
Gender:F
Credentials:RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 MONTGOMERY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7712
Mailing Address - Country:US
Mailing Address - Phone:513-631-6963
Mailing Address - Fax:513-631-1970
Practice Address - Street 1:9050 MONTGOMERY RD
Practice Address - Street 2:SUITE B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7712
Practice Address - Country:US
Practice Address - Phone:513-631-6963
Practice Address - Fax:513-631-1970
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD2137133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
D0MT03171Medicare PIN
OHDOMT003171Medicare PIN