# MICHAEL L. MOCK, DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508926718
- **Authorized official:** MICHAEL L. MOCK DDS, PA (PRESIDENT)
- **Authorized official phone:** (704) 436-9397

## Contact information

- **Practice address:** 1476 S MAIN ST., MT. PLEASANT, NC 28124-0847
- **Practice address phone:** (704) 436-9397
- **Practice address fax:** (704) 436-2203
- **Mailing address:** PO BOX 846, 1476 SOUTH MAIN ST., MT. PLEASANT, NC 28124-0847
- **Mailing address phone:** (704) 436-9397
- **Mailing address fax:** (704) 436-2203

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4518 | NC | Yes |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4518 | NC DENTAL LISCENSE | NC |
| 05 | — | 8996027 | — | NC |
| 01 | — | 96027 | BLUE CROSS AND BLUE SHIEL | NC |