| Michael A Derose Dds Pa | |
|
3053 Freedom Dr Ste B Charlotte NC 28208-3862 | |
| (704) 393-3911 | |
| (704) 392-1096 |
| Full Name | Michael A Derose Dds Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3053 Freedom Dr Ste B, Charlotte, North Carolina |
| Authorized Official Name and Position | Michael Anthony Derose (OWNER) |
| Authorized Official Contact | 3367770303 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael A Derose Dds Pa 2041 Silas Creek Pkwy Winston Salem NC 27103-5147 Ph: (336) 777-0303 | Michael A Derose Dds Pa 3053 Freedom Dr Ste B Charlotte NC 28208-3862 Ph: (704) 393-3911 |
| NPI Number | 1598793242 |
|---|---|
| Provider Enumeration Date | 06/30/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598793242 | NPI | - | NPPES |
| 013U4 | Other | BLUE CROSS BLUE SHIELD NC | |
| 89013U4 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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