Healthcare Provider Details

I. General information

NPI: 1639574601
Provider Name (Legal Business Name): S. WILLIAM ROCKINO, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2014
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 3RD ST NE
LAKE PRESTON SD
57249
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 Code261QD0000X
TaxonomyDental Clinic/Center
License NumberM377
License Number StateSD

VIII. Authorized Official

Name: SAMUEL WILLIAM ROCKINO
Title or Position: OWNER/PROVIDER
Credential: DDS
Phone: 605-847-4600