Healthcare Provider Details

I. General information

NPI: 1316691272
Provider Name (Legal Business Name): ROCKIN SMILES DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 E BOCKMAN WAY
SPARTA TN
38583-2036
US

IV. Provider business mailing address

1156 BUFFALO VALLEY RD
COOKEVILLE TN
38501-4463
US

V. Phone/Fax

Practice location:
  • Phone: 931-488-8544
  • Fax:
Mailing address:
  • Phone: 801-259-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE GRAVES
Title or Position: OFFICE MANAGER
Credential:
Phone: 931-488-8544