Provider Demographics
NPI:1568584555
Name:KY, VEROCK (DDS)
Entity Type:Individual
Prefix:
First Name:VEROCK
Middle Name:
Last Name:KY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2414
Mailing Address - Country:US
Mailing Address - Phone:559-897-2600
Mailing Address - Fax:559-897-2622
Practice Address - Street 1:1064 LEWIS ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-2414
Practice Address - Country:US
Practice Address - Phone:559-897-2600
Practice Address - Fax:559-897-2622
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54389Medicaid