Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 021002150 | IL |
NPI | 1073730131 |
---|---|
Provider Name | Anokhi Dalia Bock |
First Address | Lake Forest, IL 60045-2608 |
Second Address | Lake Forest, IL 60045-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 30/01/2009 |