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General NPI Number Information
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NPI Number | 1659624245
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Entity Type | Individual
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Provider Name | BRADLEY COBB BOCKHORST DMD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 3231 WARING CT
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City | OCEANSIDE
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State | CA
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Zip | 92056-4510
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Country | US
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Telephone | 760-732-3456
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Fax | 760-732-3404
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Provider Business Mailing Address
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Address Line | 21512 COUNTRYSIDE DR
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City | LAKE FOREST
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State | CA
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Zip | 92630-6559
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Country | US
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Telephone | 949-583-0935
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Fax | 760-732-3404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 38042
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License Number State | CA
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