Provider Demographics
NPI:1366432171
Name:ROCK, ROBERT DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:ROCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LINCOLN STREET, BLDG #9900, 2ND FLOOR
Mailing Address - Street 2:USA DENTAC JOINT BASE LEWIS-MCCHORD
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431
Mailing Address - Country:US
Mailing Address - Phone:253-968-4032
Mailing Address - Fax:315-772-9692
Practice Address - Street 1:527 BARNES BLVD
Practice Address - Street 2:MCCHORD AIR FORSE BASE DENTAL CLINIC
Practice Address - City:MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98438
Practice Address - Country:US
Practice Address - Phone:253-982-5505
Practice Address - Fax:315-772-9692
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN