MEDICARE: ROCK DENTAL TENNESSEE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
2	1223P0221X	Pediatric Dentistry
3	122300000X	Dentist

General Provider Information

NPI Number	:	1447848346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCK DENTAL TENNESSEE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3450
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72203-3450
Country	:	US
Telephone Number	:	501-781-2777
Fax Number	:	501-781-2778

Provider Business Practice Location Address
First Line	:	6551 STAGE OAKS DR STE 2
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-3895
Country	:	US
Telephone Number	:	901-386-5800
Fax Number	:	501-781-2778

Authorized Official
Title or Position	:	OWNER
Name	:	MARK L DAKE
Credential	:	DDS, MBR
Telephone Number	:	501-462-2062

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/20/2026

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