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General NPI Number Information
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NPI Number | 1588918684
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Entity Type | Organization
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Legal Business Name | REGINA H ROCHA DDS, MS, PC
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 1649 W CORTLAND ST UNIT C-101
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City | CHICAGO
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State | IL
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Zip | 60622-8974
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Country | US
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Telephone | 773-697-4348
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Fax | 773-904-7873
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Provider Business Mailing Address
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Address Line | 1649 W CORTLAND ST UNIT C-101
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City | CHICAGO
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State | IL
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Zip | 60622-8974
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. REGINA H ROCHA
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Credential | DDS
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Telephone | 773-697-4348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 319016492
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License Number State | IL
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