MEDICARE: DR. FRED POCKRASS, DDS A PROFESSIONAL CORPORATION

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	122300000X	Dentist	49191	CA

General Provider Information

NPI Number	:	1174741193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. FRED POCKRASS, DDS A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3030 ASHBY AVE STE 101
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2439
Country	:	US
Telephone Number	:	510-841-3040
Fax Number	:	510-841-3044

Provider Business Practice Location Address
First Line	:	3030 ASHBY AVE STE 101
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2439
Country	:	US
Telephone Number	:	510-841-3040
Fax Number	:	510-841-3044

Authorized Official
Title or Position	:	DENTIST
Name	:	MR. FRED POCKRASS
Credential	:	D.D.S.
Telephone Number	:	510-841-3040

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	12/16/2010

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