Healthcare Provider Details

I. General information

NPI: 1275634750
Provider Name (Legal Business Name): PAUL ALFRED ROCKE D.D.S M.S, P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W COLFAX AVE #G
DENVER CO
80204-2072
US

IV. Provider business mailing address

1050 W COLFAX AVE #G
DENVER CO
80204-2072
US

V. Phone/Fax

Practice location:
  • Phone: 303-690-3111
  • Fax: 303-730-0715
Mailing address:
  • Phone: 303-690-3111
  • Fax: 303-730-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberCO 275
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: