Provider Demographics
NPI:1841412566
Name:LAROSE, PAUL JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JEAN
Last Name:LAROSE
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 1:1634 I ST NW
Mailing Address - Street 2:SUITE 404
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-4003
Mailing Address - Country:US
Mailing Address - Phone:202-347-1220
Mailing Address - Fax:
Practice Address - Street 1:1634 I ST NW
Practice Address - Street 2:SUITE 404
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-4003
Practice Address - Country:US
Practice Address - Phone:202-347-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN45221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice