Provider Demographics
NPI:1487894838
Name:TURNOCK, JACK ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:ALAN
Last Name:TURNOCK
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 1:330 WEST LEXINGTON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516
Mailing Address - Country:US
Mailing Address - Phone:574-293-4141
Mailing Address - Fax:574-293-9816
Practice Address - Street 1:330 WEST LEXINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516
Practice Address - Country:US
Practice Address - Phone:574-293-4141
Practice Address - Fax:574-293-9816
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006435B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist