Provider Demographics
NPI:1205904869
Name:LAROSE, YVONNE C (RDH)
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:C
Last Name:LAROSE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 REDONDO DR
Mailing Address - Street 2:#202
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516
Mailing Address - Country:US
Mailing Address - Phone:630-985-1783
Mailing Address - Fax:
Practice Address - Street 1:6800 S MAIN ST
Practice Address - Street 2:STE 315
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516
Practice Address - Country:US
Practice Address - Phone:630-969-5350
Practice Address - Fax:630-969-4692
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20003142124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist