Individual
DR. NICOLET DEROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
316 5TH ST, RACINE, WI 53403-4606
(262) 534-8662
Mailing address
316 5TH ST, RACINE, WI 53403-4606
(262) 534-8662
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2362
WI
Other
Enumeration date
11/29/2006
Last updated
07/08/2007
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