Provider Demographics
NPI:1386663193
Name:DEROSE, PATRICK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:DEROSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:980 WESTFALL RD
Mailing Address - Street 2:BLDG 200, SUITE 210
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2605
Mailing Address - Country:US
Mailing Address - Phone:585-256-1500
Mailing Address - Fax:585-256-1514
Practice Address - Street 1:980 WESTFALL RD
Practice Address - Street 2:BLDG 200, SUITE 210
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2605
Practice Address - Country:US
Practice Address - Phone:585-256-1500
Practice Address - Fax:585-256-1514
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-036813-L1223G0001X
NY05546311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice