MEDICARE: FRED ZOCH DDS

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	15955	TX

General Provider Information

NPI Number	:	1942697065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRED ZOCH DDS

Provider Business Mailing Address
First Line	:	2525 TEXAS AVE
Second Line	:
City	:	BRIDGE CITY
State	:	TX
Zip	:	77611-2847
Country	:	US
Telephone Number	:	409-735-7108
Fax Number	:	409-735-6596

Provider Business Practice Location Address
First Line	:	2525 TEXAS AVE
Second Line	:
City	:	BRIDGE CITY
State	:	TX
Zip	:	77611-2847
Country	:	US
Telephone Number	:	409-735-7108
Fax Number	:	406-735-6596

Authorized Official
Title or Position	:	DENTIST
Name	:	FRED FRANKLIN ZOCH
Credential	:	DDS
Telephone Number	:	409-735-7108

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	04/16/2015

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