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General NPI Number Information
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NPI Number | 1952815482
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Entity Type | Organization
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Legal Business Name | ROBERT ROCCO DDS, PC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 130 E ALLEGAN ST
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City | OTSEGO
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State | MI
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Zip | 49078-1102
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Country | US
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Telephone | 269-698-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 133 E ALLEGAN ST
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City | OTSEGO
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State | MI
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Zip | 49078-1101
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Country | US
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Telephone | 269-698-2800
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Fax |
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | TARA LEAVELL
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Credential |
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Telephone | 269-964-3204
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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 | 016741
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License Number State | MI
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