Provider Demographics
NPI:1013010453
Name:DE LA ROSA, SERAPIO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SERAPIO
Middle Name:
Last Name:DE LA ROSA
Suffix:JR
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 1:985 SOUTH SAM HOUSTON
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586
Mailing Address - Country:US
Mailing Address - Phone:956-399-4312
Mailing Address - Fax:956-399-9337
Practice Address - Street 1:985 SOUTH SAM HOUSTON
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586
Practice Address - Country:US
Practice Address - Phone:956-399-4312
Practice Address - Fax:956-399-9337
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPI111234402Medicaid