Healthcare Provider Details

I. General information

NPI: 1376665752
Provider Name (Legal Business Name): ROCCO BERNARD CARELLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 NORWICH WESTERLY ROAD
NORTH STONINGTON CT
06359-0287
US

IV. Provider business mailing address

PO BOX 287 391 NORWICH WESTERLY ROAD
NORTH STONINGTON CT
06359-0287
US

V. Phone/Fax

Practice location:
  • Phone: 860-535-2331
  • Fax:
Mailing address:
  • Phone: 860-535-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number041492
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: