Healthcare Provider Details

I. General information

NPI: 1740106061
Provider Name (Legal Business Name): ROCK BROTHERS DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 S SOSSAMAN RD STE 101
MESA AZ
85209-3438
US

IV. Provider business mailing address

1228 S SOSSAMAN RD STE 101
MESA AZ
85209-3438
US

V. Phone/Fax

Practice location:
  • Phone: 480-396-9685
  • Fax:
Mailing address:
  • Phone: 480-396-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NELSON GORDON ROCK
Title or Position: DENTIST
Credential: DDS
Phone: 970-291-8159