Provider Demographics
NPI:1891050696
Name:BOCK, ERICA RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:RENEE
Last Name:BOCK
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 1:25412 INTERSTATE 45 N
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1351
Mailing Address - Country:US
Mailing Address - Phone:281-363-0500
Mailing Address - Fax:
Practice Address - Street 1:25412 INTERSTATE 45 N
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1351
Practice Address - Country:US
Practice Address - Phone:281-363-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX281581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice