Provider Demographics
NPI:1316439136
Name:BOCKHORST, ERICA (DDS)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BOCKHORST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 SPINNAKERS REACH DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3408
Mailing Address - Country:US
Mailing Address - Phone:904-240-4021
Mailing Address - Fax:
Practice Address - Street 1:2845 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2116
Practice Address - Country:US
Practice Address - Phone:904-240-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice