Provider Demographics
NPI:1740341882
Name:CARROCCIA, RICHARD J (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:CARROCCIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 FOULK ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2748
Mailing Address - Country:US
Mailing Address - Phone:302-477-4900
Mailing Address - Fax:302-477-4943
Practice Address - Street 1:1415 FOULK ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2748
Practice Address - Country:US
Practice Address - Phone:302-477-4900
Practice Address - Fax:302-477-4943
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10001070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001079208Medicaid