Individual
RICHARD DELA ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4 PROGRESS ST, EDISON, NJ 08820-1199
(908) 757-3191
Mailing address
44 FITZGERALD LN, COLUMBUS, NJ 08022-2387
(415) 505-7164
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0562981
NY
1223P0221X
Pediatric Dentistry
22DI02493900
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/05/2011
Last updated
09/24/2012
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