Provider Demographics
NPI:1831782598
Name:DESROSIERS, SCHADRAC (DA, RDH)
Entity type:Individual
Prefix:MR
First Name:SCHADRAC
Middle Name:
Last Name:DESROSIERS
Suffix:
Gender:M
Credentials:DA, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-5016
Mailing Address - Country:US
Mailing Address - Phone:617-682-9554
Mailing Address - Fax:
Practice Address - Street 1:117 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-5016
Practice Address - Country:US
Practice Address - Phone:617-682-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH88670124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist