Provider Demographics
NPI:1356520456
Name:CARROCCIA, DONNA MARIE (DDS)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:CARROCCIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006
Mailing Address - Country:US
Mailing Address - Phone:973-228-2335
Mailing Address - Fax:973-228-1999
Practice Address - Street 1:185 FAIRFIELD AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006
Practice Address - Country:US
Practice Address - Phone:973-228-2335
Practice Address - Fax:973-228-1999
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI015199001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice