Provider Demographics
NPI:1164773669
Name:DEROSA, ALAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:A
Last Name:DEROSA
Suffix:
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:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-0277
Mailing Address - Country:US
Mailing Address - Phone:845-246-9566
Mailing Address - Fax:845-246-8775
Practice Address - Street 1:3210 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-5237
Practice Address - Country:US
Practice Address - Phone:845-246-9566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY393601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice