Provider Demographics
NPI:1235216953
Name:MECCA, JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MECCA
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 1:151 WAKEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:NY
Mailing Address - Zip Code:13303-1816
Mailing Address - Country:US
Mailing Address - Phone:315-337-6838
Mailing Address - Fax:
Practice Address - Street 1:115 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2323
Practice Address - Country:US
Practice Address - Phone:315-724-6235
Practice Address - Fax:315-724-6524
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0425671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice