Provider Demographics
NPI:1548492481
Name:BOCK, ANDREW JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:BOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 WHITETAIL CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7000
Mailing Address - Country:US
Mailing Address - Phone:720-890-5001
Mailing Address - Fax:720-890-5001
Practice Address - Street 1:1491 DENVER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5227
Practice Address - Country:US
Practice Address - Phone:970-669-6670
Practice Address - Fax:970-669-6620
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96381223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics