Provider Demographics
NPI:1831209212
Name:ROCKOFF, PAUL R (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:ROCKOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3715 MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BRIDGEPOINT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-372-5566
Mailing Address - Fax:203-374-9989
Practice Address - Street 1:3715 MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BRIDGEPOINT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-372-5566
Practice Address - Fax:203-374-9989
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT4190204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T22039Medicare UPIN