1689762437 NPI number — DR. JEFFREY NEAL KOCKRITZ D.D.S.

Table of content: DR. JEFFREY NEAL KOCKRITZ D.D.S. (NPI 1689762437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689762437 NPI number — DR. JEFFREY NEAL KOCKRITZ D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOCKRITZ
Provider First Name:
JEFFREY
Provider Middle Name:
NEAL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689762437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2312 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE 121
Provider Business Mailing Address City Name:
BATTLE GROUND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98604-4234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-687-4721
Provider Business Mailing Address Fax Number:
360-666-1600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 SW SCOTTON WAY
Provider Second Line Business Practice Location Address:
SUITE 121
Provider Business Practice Location Address City Name:
BATTLE GROUND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98604-9860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-687-4721
Provider Business Practice Location Address Fax Number:
360-342-8909
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7426 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 7426 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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