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General NPI Number Information
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NPI Number | 1639574601
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Entity Type | Organization
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Legal Business Name | S. WILLIAM ROCKINO, DDS
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 105 3RD ST NE
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City | LAKE PRESTON
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State | SD
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Zip | 57249
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Country | US
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Telephone | 605-847-4600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 485
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City | LAKE PRESTON
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State | SD
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Zip | 57249-0485
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Country | US
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Telephone | 605-847-4600
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | SAMUEL WILLIAM ROCKINO
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Credential | DDS
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Telephone | 605-847-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | M377
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License Number State | SD
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