Provider Demographics
NPI:1861072142
Name:ROCKWOOD, KEITH (DDS)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:ROCKWOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11005 RALSTON RD STE 100G
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4551
Mailing Address - Country:US
Mailing Address - Phone:303-776-7433
Mailing Address - Fax:
Practice Address - Street 1:11005 RALSTON RD STE 100G
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4551
Practice Address - Country:US
Practice Address - Phone:303-776-7433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODEN.002050301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program