Healthcare Provider Details

I. General information

NPI: 1164381638
Provider Name (Legal Business Name): ROCK DENTAL TEXAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 N PRESTON RD STE 80
PROSPER TX
75078-2788
US

IV. Provider business mailing address

PO BOX 3450
LITTLE ROCK AR
72203-3450
US

V. Phone/Fax

Practice location:
  • Phone: 972-934-6222
  • Fax:
Mailing address:
  • Phone: 501-781-2777
  • Fax: 501-781-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SHAY PHILMO PHILMON
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 501-462-2062