Organization
MICHAEL A DEROSE DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ANTHONY DEROSE DDS (OWNER)
(336) 777-0303
Entity
Organization
Contact information
Practice address
2041 SILAS CREEK PKWY, WINSTON SALEM, NC 27103-5147
(336) 777-0303
(336) 777-3448
Mailing address
2041 SILAS CREEK PKWY, WINSTON SALEM, NC 27103-5147
(336) 777-0303
(336) 777-3448
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012P6
BLUE CROSS BLUE SHIELD NC
—
05
—
89012P6
—
NC
Enumeration date
06/19/2006
Last updated
07/21/2022
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