Provider Demographics
NPI:1275511909
Name:COCOCCETTA, GUY GABRIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:GABRIEL
Last Name:COCOCCETTA
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 1:40759 FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4438
Mailing Address - Country:US
Mailing Address - Phone:586-604-1190
Mailing Address - Fax:248-737-8950
Practice Address - Street 1:40759 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-4438
Practice Address - Country:US
Practice Address - Phone:586-604-1190
Practice Address - Fax:248-737-8950
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI011892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist