Provider Demographics
NPI:1205045168
Name:BOCCELLA, JOHN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:BOCCELLA
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 1:211 N WHITFIELD STREET
Mailing Address - Street 2:MEDICAL CENTER EAST
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3031
Mailing Address - Country:US
Mailing Address - Phone:412-441-2655
Mailing Address - Fax:412-441-2655
Practice Address - Street 1:211 N WHITFIELD STREET
Practice Address - Street 2:MEDICAL CENTER EAST
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3031
Practice Address - Country:US
Practice Address - Phone:412-441-2655
Practice Address - Fax:412-441-2655
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS014189L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist