Provider Demographics
NPI:1235514183
Name:ROSE ROCK FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:ROSE ROCK FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-377-7323
Mailing Address - Street 1:1526 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4372
Mailing Address - Country:US
Mailing Address - Phone:405-377-7323
Mailing Address - Fax:
Practice Address - Street 1:1526 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4372
Practice Address - Country:US
Practice Address - Phone:405-377-7323
Practice Address - Fax:405-372-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200399260AMedicaid