Healthcare Provider Details

I. General information

NPI: 1447340989
Provider Name (Legal Business Name): SAMUEL WILLIAM ROCKINO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 3RD STREET N.E.
LAKE PRESTON SD
57249-0485
US

IV. Provider business mailing address

PO BOX 485
LAKE PRESTON SD
57249-0485
US

V. Phone/Fax

Practice location:
  • Phone: 605-847-4600
  • Fax:
Mailing address:
  • Phone: 605-847-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberM-377
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: