MEDICARE: ROCK SPRINGS DENTAL, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1588107700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCK SPRINGS DENTAL, PLLC

Provider Business Mailing Address
First Line	:	1515 ROCK SPRINGS RD
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-8804
Country	:	US
Telephone Number	:	870-741-1060
Fax Number	:	870-741-4713

Provider Business Practice Location Address
First Line	:	1515 ROCK SPRINGS RD
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-8804
Country	:	US
Telephone Number	:	870-741-1060
Fax Number	:	870-741-4713

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN K CHRISTENSEN
Credential	:	DDS
Telephone Number	:	870-741-1060

Provider Enumeration Date	:	11/19/2016
Last Update Date	:	11/19/2016

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