Healthcare Provider Details

I. General information

NPI: 1629993258
Provider Name (Legal Business Name): DUSTIN MICHAEL SCHROCK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N PACIFIC COAST HWY STE 15
EL SEGUNDO CA
90245-3435
US

IV. Provider business mailing address

1380 VETERAN AVE APT 404
LOS ANGELES CA
90024-4830
US

V. Phone/Fax

Practice location:
  • Phone: 310-361-2258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS113584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: