Healthcare Provider Details

I. General information

NPI: 1013523216
Provider Name (Legal Business Name): LAROCK DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E MAIN ST
MANCHESTER MI
48158-8748
US

IV. Provider business mailing address

PO BOX 386
MANCHESTER MI
48158-0386
US

V. Phone/Fax

Practice location:
  • Phone: 734-428-8323
  • Fax: 734-428-1108
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AARON LAROCK
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 734-428-8323