Provider Demographics
NPI:1518079151
Name:ROCK, J KONRAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:KONRAD
Last Name:ROCK
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 1:200 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2409
Mailing Address - Country:US
Mailing Address - Phone:620-663-9133
Mailing Address - Fax:620-663-7851
Practice Address - Street 1:200 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2409
Practice Address - Country:US
Practice Address - Phone:620-663-9133
Practice Address - Fax:620-663-7851
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics