Provider Demographics
NPI:1710366398
Name:ROCHELLE E HACKLEY DDS LLC
Entity Type:Organization
Organization Name:ROCHELLE E HACKLEY DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:HACKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-816-3232
Mailing Address - Street 1:12230 ROCKVILLE PIKE
Mailing Address - Street 2:200-B
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:
Practice Address - Street 1:12230 ROCKVILLE PIKE
Practice Address - Street 2:200-B
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty