Provider Demographics
NPI:1780301952
Name:MESOLELLA DENTAL PLLC
Entity type:Organization
Organization Name:MESOLELLA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MESOLELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-794-0096
Mailing Address - Street 1:2081 W RIDGE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2724
Mailing Address - Country:US
Mailing Address - Phone:585-227-0650
Mailing Address - Fax:
Practice Address - Street 1:2081 W RIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2724
Practice Address - Country:US
Practice Address - Phone:585-227-0650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1659732048Medicaid
NY1710103825Medicaid
NY1811488737Medicaid