Provider Demographics
NPI:1780693465
Name:ROCHELEAU, MICHAEL D (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:ROCHELEAU
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 1:14 S BRYN MAUR AVE #112
Mailing Address - Street 2:
Mailing Address - City:BRYN MAUR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-519-1099
Mailing Address - Fax:610-519-9290
Practice Address - Street 1:14 S BRYN MAUR AVE #112
Practice Address - Street 2:
Practice Address - City:BRYN MAUR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-519-1099
Practice Address - Fax:610-519-9290
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028958L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
529922OtherUNITED CONCORDIA