1366432171 NPI number — DR. ROBERT DEAN ROCK DDS

Table of content: DR. ROBERT DEAN ROCK DDS (NPI 1366432171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366432171 NPI number — DR. ROBERT DEAN ROCK DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROCK
Provider First Name:
ROBERT
Provider Middle Name:
DEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366432171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LINCOLN STREET, BLDG #9900, 2ND FLOOR
Provider Second Line Business Mailing Address:
USA DENTAC JOINT BASE LEWIS-MCCHORD
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-968-4032
Provider Business Mailing Address Fax Number:
315-772-9692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
527 BARNES BLVD
Provider Second Line Business Practice Location Address:
MCCHORD AIR FORSE BASE DENTAL CLINIC
Provider Business Practice Location Address City Name:
MCCHORD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-982-5505
Provider Business Practice Location Address Fax Number:
315-772-9692
Provider Enumeration Date:
10/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  16872 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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