Provider Demographics
NPI:1164136149
Name:ROCK KIDS DENTAL LLC
Entity Type:Organization
Organization Name:ROCK KIDS DENTAL LLC
Other - Org Name:ROCK KIDS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:EBUNOLUWA
Authorized Official - Last Name:APATA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-774-0221
Mailing Address - Street 1:1631 CROFTON CTR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1343
Mailing Address - Country:US
Mailing Address - Phone:410-774-0221
Mailing Address - Fax:410-774-0251
Practice Address - Street 1:1631 CROFTON CTR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1343
Practice Address - Country:US
Practice Address - Phone:410-774-0221
Practice Address - Fax:410-774-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1831452648Medicaid
MDD76904OtherCDS
MD056005700Medicaid
MDD76904OtherCDS