Provider Demographics
NPI:1437430618
Name:ROSE ROCK DENTAL PLLC
Entity Type:Organization
Organization Name:ROSE ROCK DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-360-7800
Mailing Address - Street 1:1049 NE 12TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-5312
Mailing Address - Country:US
Mailing Address - Phone:405-360-7800
Mailing Address - Fax:
Practice Address - Street 1:1049 12TH AVE. NE
Practice Address - Street 2:SUITE 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-360-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty