Provider Demographics
NPI:1952688871
Name:ROCK, MEGAN (RDH)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ROCK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-1345
Mailing Address - Country:US
Mailing Address - Phone:218-341-6798
Mailing Address - Fax:
Practice Address - Street 1:2720 W 7TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-1345
Practice Address - Country:US
Practice Address - Phone:218-341-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH8760124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1013233873OtherJUST KIDS DENTAL INC.