MEDICARE: DR. ROBERT DEAN ROCK DDS

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
1	1223G0001X	General Practice Dentistry	16872	TX

General Provider Information

NPI Number	:	1366432171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DEAN ROCK DDS

Provider Business Mailing Address
First Line	:	LINCOLN STREET, BLDG #9900, 2ND FLOOR
Second Line	:	USA DENTAC JOINT BASE LEWIS-MCCHORD
City	:	TACOMA
State	:	WA
Zip	:	98431
Country	:	US
Telephone Number	:	253-968-4032
Fax Number	:	315-772-9692

Provider Business Practice Location Address
First Line	:	527 BARNES BLVD
Second Line	:	MCCHORD AIR FORSE BASE DENTAL CLINIC
City	:	MCCHORD
State	:	WA
Zip	:	98438
Country	:	US
Telephone Number	:	253-982-5505
Fax Number	:	315-772-9692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	05/07/2014

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