Provider Demographics
NPI:1740246248
Name:NORTHROCK DENTAL, PA
Entity type:Organization
Organization Name:NORTHROCK DENTAL, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHEER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:316-636-1222
Mailing Address - Street 1:7707 E 29TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-3403
Mailing Address - Country:US
Mailing Address - Phone:316-636-1222
Mailing Address - Fax:316-636-1268
Practice Address - Street 1:7707 E 29TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-3403
Practice Address - Country:US
Practice Address - Phone:316-636-1222
Practice Address - Fax:316-636-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS59131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty