Provider Demographics
NPI:1417067513
Name:PATELLA, ROCCO G (DMD)
Entity Type:Individual
Prefix:
First Name:ROCCO
Middle Name:G
Last Name:PATELLA
Suffix:
Gender:M
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:PO BOX 206
Mailing Address - Street 2:11940 W US HWY 42
Mailing Address - City:GOSHEN
Mailing Address - State:KY
Mailing Address - Zip Code:40026
Mailing Address - Country:US
Mailing Address - Phone:502-228-5122
Mailing Address - Fax:
Practice Address - Street 1:11940 WEST US HWY 42
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:KY
Practice Address - Zip Code:40026
Practice Address - Country:US
Practice Address - Phone:502-228-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist