MEDICARE: BOCK AND HUTCHINSON, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9039	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144570003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOCK AND HUTCHINSON, PLLC

Provider Business Mailing Address
First Line	:	1953 POTTERY AVE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-2558
Country	:	US
Telephone Number	:	360-876-6211
Fax Number	:	360-876-7952

Provider Business Practice Location Address
First Line	:	1953 POTTERY AVE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-2558
Country	:	US
Telephone Number	:	360-876-6211
Fax Number	:	360-876-7952

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	MRS. SUSAN LYNN BOCK
Credential	:
Telephone Number	:	360-876-6211

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	09/18/2012

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