Provider Demographics
NPI:1588918684
Name:REGINA H ROCHA DDS, MS, PC
Entity type:Organization
Organization Name:REGINA H ROCHA DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-697-4348
Mailing Address - Street 1:1649 W CORTLAND ST UNIT C-101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8974
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1649 W CORTLAND ST UNIT C-101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8974
Practice Address - Country:US
Practice Address - Phone:773-697-4348
Practice Address - Fax:773-904-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319016492305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL319016492OtherENDODONTIC SPECIALIST