Provider Demographics
NPI:1124215470
Name:ROARK DENTAL SERVICES PSC
Entity Type:Organization
Organization Name:ROARK DENTAL SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:ROARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-948-5500
Mailing Address - Street 1:E-43 ALAMO DRIVE
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 167 KM 22.6
Practice Address - Street 2:OFICINA DENTAL MYPENMERCADO PITUSA BAYAMON
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-288-5994
Practice Address - Fax:787-288-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty