Provider Demographics
NPI:1902321136
Name:ROCK STREET PEDODONTICS INC
Entity Type:Organization
Organization Name:ROCK STREET PEDODONTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN REGENMORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:774-357-5670
Mailing Address - Street 1:551 ROCK ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-3435
Mailing Address - Country:US
Mailing Address - Phone:774-357-5670
Mailing Address - Fax:774-357-5687
Practice Address - Street 1:551 ROCK ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3435
Practice Address - Country:US
Practice Address - Phone:774-357-5670
Practice Address - Fax:774-357-5687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty