Provider Demographics
NPI:1689102972
Name:ROSSER, ROCKEY JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROCKEY
Middle Name:JAMES
Last Name:ROSSER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8203 W ORAIBI DR APT 2093
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-6600
Mailing Address - Country:US
Mailing Address - Phone:541-810-1912
Mailing Address - Fax:
Practice Address - Street 1:781 S COTTON LN STE 100
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-4644
Practice Address - Country:US
Practice Address - Phone:623-882-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0097241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice