Provider Demographics
NPI:1285744573
Name:TODD A SCHOCK PC DMD MD
Entity type:Organization
Organization Name:TODD A SCHOCK PC DMD MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SKAUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-382-7981
Mailing Address - Street 1:1893 NE NEFF RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6112
Mailing Address - Country:US
Mailing Address - Phone:541-382-1791
Mailing Address - Fax:541-389-6953
Practice Address - Street 1:1893 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6112
Practice Address - Country:US
Practice Address - Phone:541-382-1791
Practice Address - Fax:541-389-6953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR288477261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR136849Medicare PIN