Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | DNCS000195 | GA |
Y | 1223P0221X | Pediatric Dentist | DNF000308 | GA |
NPI | 1053350694 |
---|---|
Provider Name | Dr. Roy A Rockman |
First Address | Augusta, GA 30912-0001 |
Second Address | Augusta, GA 30912-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 25/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000942004A | (05) | GA |
ZG0308 | (05) | SC |