Provider Demographics
NPI:1467560490
Name:STONEROCK, ROBERT L (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:STONEROCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF THE ARMY DENTAL ACTIVITY STOP
Mailing Address - Street 2:2817 REILLY RD, MCDS-NA-B
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-396-5610
Mailing Address - Fax:910-396-7017
Practice Address - Street 1:DEPARTMENT OF THE ARMY DENTAL ACTIVITY STOP
Practice Address - Street 2:2817 REILLY RD, MCDS-NA-B
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-396-5610
Practice Address - Fax:910-396-7017
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCID00201223P0221X
CO8011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX0020Medicaid
SCAA0655Medicare ID - Type Unspecified
V01766Medicare UPIN