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Contact Information

GREGORY DEROSE JR, DDS
7223 MISSISSIPPI AVENUE
BLDG 1561
FORT POLK, LA71459
 Phone: 337-531-2603
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for GREGORY DEROSE JR · (Male)

NPI # 1225601511
Status Active
Credentials DDS (Doctor of Dental Surgery)
Entity Individual
Enumeration date 07/23/2021
Last updated 07/23/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • AR License # 4515
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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