Provider Demographics
NPI:1659597946
Name:HACKLEY, ROCHELLE ELISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:ELISE
Last Name:HACKLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12230 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1672
Mailing Address - Country:US
Mailing Address - Phone:301-816-3232
Mailing Address - Fax:301-816-7869
Practice Address - Street 1:12230 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 200B
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1672
Practice Address - Country:US
Practice Address - Phone:301-816-3232
Practice Address - Fax:301-816-7869
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice