Organization
REGINA H ROCHA DDS, MS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGINA H ROCHA DDS (DOCTOR/OWNER)
(773) 697-4348
Entity
Organization
Contact information
Practice address
1649 W CORTLAND ST UNIT C-101, CHICAGO, IL 60622-8974
(773) 697-4348
(773) 904-7873
Mailing address
1649 W CORTLAND ST UNIT C-101, CHICAGO, IL 60622-8974
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
319016492
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
319016492
ENDODONTIC SPECIALIST
IL
Enumeration date
10/29/2012
Last updated
10/29/2012
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