Derose, Michael Anthony

Derose, Michael Anthony is an individual health care provider with primary practice located at 1022 Liberty Ln , Pueblo CO 81001-2039. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Derose, Michael Anthony can be contacted via phone (719) 545-5778.

Contact Information

Primary practice address
1022 Liberty Ln Pueblo CO 81001-2039
Phone: (719) 545-5778
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X DEN-5133 Colorado
Dental Providers / General Practice 1223G0001X 12010424A Indiana
Dental Providers / General Practice 1223G0001X 5643 Oklahoma
Dental Providers / General Practice 1223G0001X DD2030 New Mexico
Dental Providers / General Practice 1223G0001X 60184 Kansas

Profile Details

NPI number 1033185871
LBN Legal business name Derose, Michael Anthony
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 23rd, 2006
Last updated Jul 9th, 2007 - about 17 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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Identifiers

StateTypeNumberIssuer
All States NPI 1033185871 NPPES
Colorado MEDICAID 2051332

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