Individual
SCOTT S DEROSSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1430 JOHN WESLEY GILBERT DRIVE, GC-1024, GHSU COLLEGE OF DENTAL MEDICINE, AUGUSTA, GA 30912-1001
(706) 721-9633
(706) 723-0266
Mailing address
1430 JOHN WESLEY GILBERT DRIVE, GC-1024, GHSU COLLEGE OF DENTAL MEDICINE, AUGUSTA, GA 30912-1001
(706) 721-9633
(706) 723-0266
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DS029512L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016969200001
—
PA
Enumeration date
06/14/2006
Last updated
11/30/2012
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