Provider Demographics
NPI:1619723780
Name:MESORACA, ROCCO JOSEPH III (DMD)
Entity type:Individual
Prefix:
First Name:ROCCO
Middle Name:JOSEPH
Last Name:MESORACA
Suffix:III
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 1:818 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3906
Mailing Address - Country:US
Mailing Address - Phone:610-306-9599
Mailing Address - Fax:
Practice Address - Street 1:5000 CHICHESTER AVE
Practice Address - Street 2:
Practice Address - City:UPPER CHICHESTER
Practice Address - State:PA
Practice Address - Zip Code:19014-2333
Practice Address - Country:US
Practice Address - Phone:610-485-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist