Provider Demographics
NPI:1639242639
Name:ROCKWELL, LANDON BRET (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANDON
Middle Name:BRET
Last Name:ROCKWELL
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 1:181 W VINE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2036
Mailing Address - Country:US
Mailing Address - Phone:435-882-0099
Mailing Address - Fax:435-882-1040
Practice Address - Street 1:181 W VINE ST
Practice Address - Street 2:SUITE A
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2036
Practice Address - Country:US
Practice Address - Phone:435-882-0099
Practice Address - Fax:435-882-1040
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56720921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice