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Individual
DR. JEREMY DAVID DEROSE
Active
Individual
DR. JEREMY DAVID DEROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7248
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7248
LOUISIANA STATE BOARD OF DENTISTRY
LA
Enumeration date
06/28/2021
Last updated
06/29/2021
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