Provider Demographics
NPI:1871133405
Name:ROCCO, HEIDI ALEXANDRA LA ROCCO
Entity type:Individual
Prefix:
First Name:HEIDI ALEXANDRA
Middle Name:LA ROCCO
Last Name:ROCCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 LODGE POLE CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-6045
Mailing Address - Country:US
Mailing Address - Phone:195-144-5526
Mailing Address - Fax:
Practice Address - Street 1:330 E TUDOR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7369
Practice Address - Country:US
Practice Address - Phone:907-522-1991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90468126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Single Specialty