Provider Demographics
NPI:1669674842
Name:MOCCIA-PATTON, MELISSA DARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:DARIA
Last Name:MOCCIA-PATTON
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 1:3733 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3286
Mailing Address - Country:US
Mailing Address - Phone:313-563-1860
Mailing Address - Fax:
Practice Address - Street 1:3733 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3286
Practice Address - Country:US
Practice Address - Phone:313-563-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010196111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice