Provider Demographics
NPI:1447508379
Name:BOCKENFELD, ELESA (DDS)
Entity type:Individual
Prefix:
First Name:ELESA
Middle Name:
Last Name:BOCKENFELD
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 1:3429 WESTMINSTER AVE
Mailing Address - Street 2:# 4
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5601
Mailing Address - Country:US
Mailing Address - Phone:214-702-1451
Mailing Address - Fax:
Practice Address - Street 1:3904 COLGATE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5423
Practice Address - Country:US
Practice Address - Phone:214-702-1451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28382122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist