Provider Demographics
NPI:1093873283
Name:MOCCIO, RAYMOND MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:MARK
Last Name:MOCCIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 S FAIRFIELD AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:630-515-0900
Mailing Address - Fax:630-515-0198
Practice Address - Street 1:2801 S FAIRFIELD AVE
Practice Address - Street 2:SUITE I
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-515-0900
Practice Address - Fax:630-515-0198
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice