Provider Demographics
NPI:1861467920
Name:ROCK, MARY (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:ROCK
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 1:3740 COORS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4762
Mailing Address - Country:US
Mailing Address - Phone:505-836-1280
Mailing Address - Fax:505-839-4782
Practice Address - Street 1:3740 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4762
Practice Address - Country:US
Practice Address - Phone:505-836-1280
Practice Address - Fax:505-839-4782
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM24791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice