Provider Demographics
NPI:1114081692
Name:DEROSE FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:DEROSE FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-963-3894
Mailing Address - Street 1:131 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3416
Mailing Address - Country:US
Mailing Address - Phone:269-963-3894
Mailing Address - Fax:269-963-3980
Practice Address - Street 1:131 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3416
Practice Address - Country:US
Practice Address - Phone:269-963-3894
Practice Address - Fax:269-963-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI183011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty