Provider Demographics
NPI:1720179641
Name:SCHROCK, HAL MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:MARK
Last Name:SCHROCK
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 NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3933
Mailing Address - Country:US
Mailing Address - Phone:601-798-8207
Mailing Address - Fax:601-798-6253
Practice Address - Street 1:200 NORWOOD ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3933
Practice Address - Country:US
Practice Address - Phone:601-798-8207
Practice Address - Fax:601-798-6253
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1810-781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice