Provider Demographics
NPI:1477757821
Name:MICHAEL A. LAROSA DDS. P.C.
Entity Type:Organization
Organization Name:MICHAEL A. LAROSA DDS. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-668-8555
Mailing Address - Street 1:1050 FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3704
Mailing Address - Country:US
Mailing Address - Phone:716-668-8555
Mailing Address - Fax:716-668-1110
Practice Address - Street 1:1050 FRENCH RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-3704
Practice Address - Country:US
Practice Address - Phone:716-668-8555
Practice Address - Fax:716-668-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040242261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
00513209OtherUNITED CONCORDIA PROV.
NY4000528OtherI.H.A. PROV. NUMBER
NY040242OtherNYS LICENSE NUMBER