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General NPI Number Information
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NPI Number | 1316691272
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Entity Type | Organization
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Legal Business Name | ROCKIN SMILES DENTAL PLLC
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 154 E BOCKMAN WAY
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City | SPARTA
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State | TN
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Zip | 38583-2036
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Country | US
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Telephone | 931-488-8544
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Fax |
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Provider Business Mailing Address
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Address Line | 1156 BUFFALO VALLEY RD
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City | COOKEVILLE
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State | TN
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Zip | 38501-4463
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Country | US
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Telephone | 801-259-1833
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHELLE GRAVES
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Credential |
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Telephone | 931-488-8544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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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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