Provider Demographics
NPI:1699745414
Name:ROCK, RENITA MARIE (RDH)
Entity type:Individual
Prefix:MS
First Name:RENITA
Middle Name:MARIE
Last Name:ROCK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5012
Mailing Address - Country:US
Mailing Address - Phone:757-410-2508
Mailing Address - Fax:
Practice Address - Street 1:905 DEER PATH
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5012
Practice Address - Country:US
Practice Address - Phone:757-410-2508
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4096124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist