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General NPI Number Information
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NPI Number | 1811488737
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Entity Type | Individual
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Provider Name | ANTHONY RICHARD MESOLELLA DDS
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Gender | Male
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Dates
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Enumeration Date | 05/26/2018
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 2081 W RIDGE RD STE 204
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City | ROCHESTER
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State | NY
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Zip | 14626
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Country | US
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Telephone | 585-794-0096
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Fax |
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Provider Business Mailing Address
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Address Line | 2081 W RIDGE RD STE 204
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City | ROCHESTER
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State | NY
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Zip | 14626-2724
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Country | US
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Telephone | 585-794-0096
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 060455
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License Number State | NY
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