MEDICARE: DR. GLENN KEVIN ROCHLEN DENTIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	040418	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194926287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN KEVIN ROCHLEN DENTIST

Provider Business Mailing Address
First Line	:	6 TONI PL
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-3041
Country	:	US
Telephone Number	:	718-479-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	11206 SPRINGFIELD BLVD
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-2650
Country	:	US
Telephone Number	:	718-479-4100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	02/19/2016

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