Provider Demographics
NPI:1831536861
Name:LEROSE, CLAUDE CHARLES JR (DDS)
Entity type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:CHARLES
Last Name:LEROSE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:20675 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1618
Mailing Address - Country:US
Mailing Address - Phone:313-885-8344
Mailing Address - Fax:313-885-1819
Practice Address - Street 1:20675 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-885-8344
Practice Address - Fax:313-885-1819
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010209491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery