Provider Demographics
NPI:1033854351
Name:MARY P ROCK
Entity Type:Organization
Organization Name:MARY P ROCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-228-3130
Mailing Address - Street 1:7707 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9604
Mailing Address - Country:US
Mailing Address - Phone:505-228-3130
Mailing Address - Fax:
Practice Address - Street 1:1840 MADISON AVE STE 1
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5292
Practice Address - Country:US
Practice Address - Phone:505-228-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty