Provider Demographics
NPI:1790123198
Name:MOROCHO, WILSON F (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:F
Last Name:MOROCHO
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 1:6358 WETHEROLE ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2930
Mailing Address - Country:US
Mailing Address - Phone:718-459-4700
Mailing Address - Fax:
Practice Address - Street 1:6358 WETHEROLE ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2930
Practice Address - Country:US
Practice Address - Phone:718-459-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0574541223G0001X
OH30.024649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty