Provider Demographics
NPI:1851656334
Name:DEROSA, DANIEL F (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:F
Last Name:DEROSA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 COMMERCE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2714
Mailing Address - Country:US
Mailing Address - Phone:267-460-4254
Mailing Address - Fax:215-646-6199
Practice Address - Street 1:450 CRESSON BLVD.
Practice Address - Street 2:SUITE 210
Practice Address - City:OAKS
Practice Address - State:PA
Practice Address - Zip Code:19456
Practice Address - Country:US
Practice Address - Phone:610-482-4334
Practice Address - Fax:610-539-1055
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0391771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice