Provider Demographics
NPI:1902916802
Name:MECCA, JOSEPH C (DMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:MECCA
Suffix:
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 1:14535 BEL RED RD
Mailing Address - Street 2:102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3907
Mailing Address - Country:US
Mailing Address - Phone:425-865-8128
Mailing Address - Fax:425-865-0193
Practice Address - Street 1:14535 BELLEVUE REDMOND ROAD
Practice Address - Street 2:#102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3907
Practice Address - Country:US
Practice Address - Phone:425-865-8128
Practice Address - Fax:425-865-0193
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA52901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice