Provider Demographics
NPI:1568644201
Name:DEROSSET, MARGAUX MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARGAUX
Middle Name:MARIE
Last Name:DEROSSET
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7138
Mailing Address - Country:US
Mailing Address - Phone:312-642-3370
Mailing Address - Fax:
Practice Address - Street 1:939 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7138
Practice Address - Country:US
Practice Address - Phone:312-642-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist