Individual
VAN PELT ROCKEFELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1178 GRIMES BRIDGE RD STE 100, ROSWELL, GA 30075-3935
(770) 992-7550
Mailing address
2885 STONECREEK ROAD, SMYRNA, GA 30080
(317) 529-4047
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN015157
GA
225100000X
Physical Therapist
PT9110
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/09/2007
Last updated
08/09/2016
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