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General NPI Number Information
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NPI Number | 1033854351
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Entity Type | Organization
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Legal Business Name | MARY P ROCK
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 1840 MADISON AVE STE 1
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-5292
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Country | US
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Telephone | 505-228-3130
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Fax |
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Provider Business Mailing Address
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Address Line | 7707 S 23RD ST
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City | LINCOLN
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State | NE
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Zip | 68512-9604
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Country | US
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Telephone | 505-228-3130
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARY P ROCK
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Credential | DDS
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Telephone | 505-228-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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