Provider Demographics
NPI:1063586857
Name:HANCOCK, JEFFREY BISHOP (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BISHOP
Last Name:HANCOCK
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 1:3919 PARKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-6566
Mailing Address - Country:US
Mailing Address - Phone:936-559-1910
Mailing Address - Fax:936-564-9776
Practice Address - Street 1:1125 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4248
Practice Address - Country:US
Practice Address - Phone:936-564-2005
Practice Address - Fax:936-564-9776
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice