Healthcare Provider Details

I. General information

NPI: 1689762437
Provider Name (Legal Business Name): JEFFREY NEAL KOCKRITZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 SW SCOTTON WAY SUITE 121
BATTLE GROUND WA
98604-9860
US

IV. Provider business mailing address

2312 W MAIN ST SUITE 121
BATTLE GROUND WA
98604-4234
US

V. Phone/Fax

Practice location:
  • Phone: 360-687-4721
  • Fax: 360-342-8909
Mailing address:
  • Phone: 360-687-4721
  • Fax: 360-666-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7426
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7426
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: