Provider Demographics
NPI:1245460203
Name:MECUA, RICHARD ROSELLO (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROSELLO
Last Name:MECUA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17735 HESPERIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-3034
Mailing Address - Country:US
Mailing Address - Phone:510-278-7727
Mailing Address - Fax:510-278-5610
Practice Address - Street 1:17735 HESPERIAN BLVD
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-3034
Practice Address - Country:US
Practice Address - Phone:510-278-7727
Practice Address - Fax:510-278-5610
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice