Provider Demographics
NPI:1326184169
Name:PLOCKI, DAVID R (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:PLOCKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MORRO HILLS RD
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-9202
Mailing Address - Country:US
Mailing Address - Phone:760-728-3677
Mailing Address - Fax:
Practice Address - Street 1:25460 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5985
Practice Address - Country:US
Practice Address - Phone:951-698-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery