MEDICARE: ANOKHI DALIA BOCK D.M.D , M.S.D.

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	1223P0221X	Pediatric Dentistry	021002150	IL

General Provider Information

NPI Number	:	1073730131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANOKHI DALIA BOCK D.M.D , M.S.D.

Provider Business Mailing Address
First Line	:	840 S WAUKEGAN RD
Second Line	:	SUITE 107
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2608
Country	:	US
Telephone Number	:	847-615-5437
Fax Number	:	847-615-2955

Provider Business Practice Location Address
First Line	:	840 S WAUKEGAN RD
Second Line	:	SUITE 107
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2608
Country	:	US
Telephone Number	:	847-615-5437
Fax Number	:	847-615-2955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	01/30/2009

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