Provider Demographics
NPI:1942398417
Name:TRUOCCHIO, MICHAEL ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:TRUOCCHIO
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 1:110 NORTH OCEAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-447-0004
Mailing Address - Fax:631-667-1751
Practice Address - Street 1:110 NORTH OCEAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-447-0004
Practice Address - Fax:631-667-1751
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34330122300000X
NY034330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034330OtherDENTAL LICENSE