Provider Demographics
NPI:1700195807
Name:D'OCCHIO, MICHAEL ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:D'OCCHIO
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 1:6 DAVIS RD W
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1448
Mailing Address - Country:US
Mailing Address - Phone:860-434-5565
Mailing Address - Fax:860-434-5880
Practice Address - Street 1:6 DAVIS RD W
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1448
Practice Address - Country:US
Practice Address - Phone:860-434-5565
Practice Address - Fax:860-434-5880
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214431223G0001X
CT0093671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice