Provider Demographics
NPI:1851407647
Name:LEROSE, CLAUDE CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:CHARLES
Last Name:LEROSE
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 1:1900 HOLLISTER DRIVE
Mailing Address - Street 2:STE #190
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-680-0975
Mailing Address - Fax:
Practice Address - Street 1:1900 HOLLISTER DRIVE
Practice Address - Street 2:STE #190
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:847-680-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist