Individual
DR. JAMES L BOCKWOLDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, PC
Contact information
Practice address
2620 JACKSON BLVD, SUITE B, RAPID CITY, SD 57702-1502
(605) 348-1712
(605) 716-7529
Mailing address
2620 JACKSON BLVD, SUITE B, RAPID CITY, SD 57702-1502
(605) 348-1712
(605) 716-7529
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
M636
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7809990
—
SD
01
—
785779
UNITED CONCORDIA
SD
Enumeration date
10/05/2006
Last updated
07/08/2007
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