Provider Demographics
NPI:1861551855
Name:DIROCCO, DONALD J (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:DIROCCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 ASHBY AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2002
Mailing Address - Country:US
Mailing Address - Phone:510-845-8780
Mailing Address - Fax:510-845-8790
Practice Address - Street 1:2414 ASHBY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2002
Practice Address - Country:US
Practice Address - Phone:510-845-8780
Practice Address - Fax:510-845-8790
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice