Provider Demographics
NPI:1750513560
Name:SOLID ROCK DENTISTRY, P.C.
Entity type:Organization
Organization Name:SOLID ROCK DENTISTRY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-620-1000
Mailing Address - Street 1:2600 HIGHWAY 58
Mailing Address - Street 2:SUITE H
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080-3735
Mailing Address - Country:US
Mailing Address - Phone:205-620-1000
Mailing Address - Fax:205-620-0333
Practice Address - Street 1:2600 HIGHWAY 58
Practice Address - Street 2:SUITE H
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-3735
Practice Address - Country:US
Practice Address - Phone:205-620-1000
Practice Address - Fax:205-620-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910982Medicaid