Provider Demographics
NPI:1154101285
Name:ROCHA, CORA L (PHDH, RDH)
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:L
Last Name:ROCHA
Suffix:
Gender:F
Credentials:PHDH, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 COLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE COMPTON
Mailing Address - State:RI
Mailing Address - Zip Code:02837-2014
Mailing Address - Country:US
Mailing Address - Phone:401-418-4671
Mailing Address - Fax:
Practice Address - Street 1:114 COLEBROOK RD
Practice Address - Street 2:
Practice Address - City:LITTLE COMPTON
Practice Address - State:RI
Practice Address - Zip Code:02837-2014
Practice Address - Country:US
Practice Address - Phone:401-418-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPDH00046124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist