Derose, Gregory
Derose, Gregory is an individual health care provider with primary practice located at 7223 Mississippi Avenue Bldg 1561, Fort Polk LA 71459. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Derose, Gregory can be contacted via phone (337) 531-2603.Contact Information
Primary practice address
7223 Mississippi Avenue Bldg 1561
Fort Polk LA 71459
Phone: (337) 531-2603
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 4515 | Arkansas |
Profile Details
| NPI number | 1225601511 |
|---|---|
| LBN Legal business name | Derose, Gregory |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 23rd, 2021 |
| Last updated | Jul 23rd, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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