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General NPI Number Information
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NPI Number | 1306515176
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Entity Type | Organization
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Legal Business Name | ROCHELLE DENTAL PARTNERS LLC
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 5 W PASSAIC ST
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3200
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Country | US
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Telephone | 201-843-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 5515 KENNEDY BLVD E
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-3510
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Country | US
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Telephone | 732-853-2701
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | THOMAS J VICCARO
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Credential | DMD
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Telephone | 973-617-7214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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