Provider Demographics
NPI:1982771168
Name:BOCK, JAKOB CHRIS (DMD)
Entity Type:Individual
Prefix:MR
First Name:JAKOB
Middle Name:CHRIS
Last Name:BOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 POTTERY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2592
Mailing Address - Country:US
Mailing Address - Phone:360-876-6211
Mailing Address - Fax:360-876-7952
Practice Address - Street 1:1950 POTTERY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2592
Practice Address - Country:US
Practice Address - Phone:360-876-6211
Practice Address - Fax:360-876-7952
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA90391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1516156OtherUNITED CONCORDIA PROV #
WA0212605OtherL & I PROVIDER #
WA5044466Medicare ID - Type UnspecifiedDSHS PROVIDER #