Provider Demographics
NPI:1861233868
Name:ROCKWELL, ERIC (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:ROCKWELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OLD STABLE WAY
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2217
Mailing Address - Country:US
Mailing Address - Phone:732-977-5116
Mailing Address - Fax:
Practice Address - Street 1:224 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7566
Practice Address - Country:US
Practice Address - Phone:732-977-5116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI030390001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice