Provider Demographics
NPI:1598957185
Name:ROCKNAK, SHAUN ROGER (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:ROGER
Last Name:ROCKNAK
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 1:7112 COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2641
Mailing Address - Country:US
Mailing Address - Phone:307-634-6020
Mailing Address - Fax:307-514-5960
Practice Address - Street 1:7112 COMMONS CIR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-2641
Practice Address - Country:US
Practice Address - Phone:307-634-6020
Practice Address - Fax:307-514-5960
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13021223G0001X
CO100971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice