Provider Demographics
NPI:1952815482
Name:ROBERT ROCCO DDS, PC
Entity Type:Organization
Organization Name:ROBERT ROCCO DDS, PC
Other - Org Name:GREATER MICHIGAN DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-964-3204
Mailing Address - Street 1:133 E ALLEGAN ST
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078-1101
Mailing Address - Country:US
Mailing Address - Phone:269-698-2800
Mailing Address - Fax:
Practice Address - Street 1:130 E ALLEGAN ST
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MI
Practice Address - Zip Code:49078-1102
Practice Address - Country:US
Practice Address - Phone:269-698-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI016741261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental