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General NPI Number Information
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NPI Number | 1780666974
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Entity Type | Organization
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Legal Business Name | MEREDITH C MOCK DDS INC
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3727 N 1ST ST SUITE 102
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City | FRESNO
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State | CA
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Zip | 93726-5628
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Country | US
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Telephone | 559-229-3541
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Fax |
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Provider Business Mailing Address
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Address Line | 3727 N 1ST ST SUITE 102
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City | FRESNO
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State | CA
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Zip | 93726-5628
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Country | US
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Telephone | 559-229-3541
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Fax | 559-229-2421
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | MEREDITH COLE MOCK
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Credential | DDS
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Telephone | 559-229-3541
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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 | 21170
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License Number State | CA
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