Provider Demographics
NPI:1912039348
Name:LA ROSA, SILVIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SILVIA
Middle Name:
Last Name:LA ROSA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 S MILDRED ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1627
Mailing Address - Country:US
Mailing Address - Phone:253-565-4700
Mailing Address - Fax:253-564-0102
Practice Address - Street 1:1628 S MILDRED ST
Practice Address - Street 2:SUITE 210
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1627
Practice Address - Country:US
Practice Address - Phone:253-565-4700
Practice Address - Fax:253-564-0102
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000090381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics