Provider Demographics
NPI:1447340989
Name:ROCKINO, SAMUEL WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WILLIAM
Last Name:ROCKINO
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:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:LAKE PRESTON
Mailing Address - State:SD
Mailing Address - Zip Code:57249-0485
Mailing Address - Country:US
Mailing Address - Phone:605-847-4600
Mailing Address - Fax:
Practice Address - Street 1:105 3RD STREET N.E.
Practice Address - Street 2:
Practice Address - City:LAKE PRESTON
Practice Address - State:SD
Practice Address - Zip Code:57249-0485
Practice Address - Country:US
Practice Address - Phone:605-847-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM-3771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7800810Medicaid