Provider Demographics
NPI:1366637050
Name:BRIAN R. ROCKEY D.D.S. INC
Entity Type:Organization
Organization Name:BRIAN R. ROCKEY D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-845-0809
Mailing Address - Street 1:200 TELETECH DRIVE
Mailing Address - Street 2:BUILDING 1 SUITE A
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-2336
Mailing Address - Country:US
Mailing Address - Phone:304-845-0809
Mailing Address - Fax:304-845-0499
Practice Address - Street 1:200 TELETECH DRIVE
Practice Address - Street 2:BUILDING 1 SUITE A
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-2336
Practice Address - Country:US
Practice Address - Phone:304-845-0809
Practice Address - Fax:304-845-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3458261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental