Provider Demographics
NPI:1073080016
Name:ROMAN ROCCA, TELLY (DMD)
Entity Type:Individual
Prefix:
First Name:TELLY
Middle Name:
Last Name:ROMAN ROCCA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 PASEO ADONIS
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4224
Mailing Address - Country:US
Mailing Address - Phone:787-619-3774
Mailing Address - Fax:
Practice Address - Street 1:CARR. #2 KM. 65.6 BO FACTOR 1
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-650-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist