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General NPI Number Information
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NPI Number | 1629993258
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Entity Type | Individual
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Provider Name | DUSTIN MICHAEL SCHROCK DDS
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Gender | Male
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Dates
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Enumeration Date | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 630 N PACIFIC COAST HWY STE 15
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City | EL SEGUNDO
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State | CA
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Zip | 90245-3435
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Country | US
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Telephone | 310-361-2258
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Fax |
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Provider Business Mailing Address
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Address Line | 1380 VETERAN AVE APT 404
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City | LOS ANGELES
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State | CA
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Zip | 90024-4830
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DDS113584
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License Number State | CA
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