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NPI Code Detail

MEDICARE: ROCKIN SMILES DENTAL PLLC

MEDICARE: ROCKIN SMILES DENTAL PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
21223G0001XGeneral Practice Dentistry
31223P0221XPediatric Dentistry
4122300000XDentist

General Provider Information

NPI Number : 1316691272
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROCKIN SMILES DENTAL PLLC
Provider Business Mailing Address
First Line : 1156 BUFFALO VALLEY RD
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-4463
Country : US
Telephone Number : 801-259-1833
Fax Number :
Provider Business Practice Location Address
First Line : 154 E BOCKMAN WAY
Second Line :
City : SPARTA
State : TN
Zip : 38583-2036
Country : US
Telephone Number : 931-488-8544
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : MICHELLE GRAVES
Credential :
Telephone Number : 931-488-8544
Provider Enumeration Date : 02/09/2022
Last Update Date : 03/15/2022

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Directions to “ROCKIN SMILES DENTAL PLLC ” Practice Location

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