Provider Demographics
NPI:1255496584
Name:HARRISON, ROCHELLE LEVETTE (DMD)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:LEVETTE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 NOB HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523
Mailing Address - Country:US
Mailing Address - Phone:914-347-4134
Mailing Address - Fax:914-347-4134
Practice Address - Street 1:4600 BROADWAY
Practice Address - Street 2:IS 218 DENTAL CLINIC CHILDRENS AID SOCIETY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040
Practice Address - Country:US
Practice Address - Phone:212-567-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00583702Medicaid