Provider Demographics
NPI:1538118880
Name:COCCHI, MARK EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:COCCHI
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 1:2880 ATLANTIC AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1724
Mailing Address - Country:US
Mailing Address - Phone:562-426-0778
Mailing Address - Fax:
Practice Address - Street 1:2880 ATLANTIC AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1724
Practice Address - Country:US
Practice Address - Phone:562-426-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB34319-01Medicaid