DEROSE CHILDREN'S DENTAL CLINIC, PC (NPI# 1699724831) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699724831 |
| Entity Type | Organization |
| Organization Name | DEROSE CHILDREN'S DENTAL CLINIC, PC |
| Practice Address |
1022 Liberty Ln Pueblo CO 81001-2039 |
| Mailing Address |
201 W 8th St Suite 810 Pueblo CO 81003-3038 |
| Practice Telephone | 7195455775 |
| Mailing Telephone | 7195624447 |
| Enumeration Date | 2006-05-07 |
| Last Update Date | 2010-05-17 |
| Authorized Official Name | MS. TRUDY WILLIAMS (DIRECTOR, LICENSING & CREDENTIALING) |
| Authorized Official Telephone | 6157500342 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 42852561 | 05 |
| Street Address |
1022 LIBERTY LN |
| City | PUEBLO |
| State | CO |
| Zip Code | 81001-2039 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881671436 | Adolph Ralph Padula | Dentist | 1022 Liberty Ln, Pueblo, CO 81001-2039 | 2005-12-26 |
| 1447633953 | Braces4kids, Pllc | Dentist | 1022 Liberty Ln, Pueblo, CO 81001-2039 | 2015-07-01 |
| 1578822375 | Family & Kids Dental PC | Dentist | 1022 Liberty Ln, Pueblo, CO 81001-2039 | 2012-05-14 |
| 1922304237 | Kunjan Kakar | Dentist | 1022 Liberty Ln, Pueblo, CO 81001-2039 | 2011-02-03 |
| 1790941912 | Prathima Rasamesetty | Dentist | 1022 Liberty Ln, Family & Kids Dental, Pueblo, CO 81001-2039 | 2008-08-07 |
| 1033185871 | Michael Anthony Derose | Dentist | 1022 Liberty Ln, Pueblo, CO 81001-2039 | 2006-02-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588222863 | 1111 Bonforte Opco LLC | Respite Care | 855 Hunter Dr., Pueblo, CO 81001 | 2019-06-03 |
| 1992276026 | Andrew Benjamin Basham | Counselor | 1003 Rupple St Pueblo Co 81001, 606, Pueblo, CO 81001 | 2018-12-16 |
| 1316456981 | Amy R Leibli | Nurse Practitioner | 1080 Chinook Lane, Pueblo, CO 81001 | 2017-09-26 |
| 1457781262 | Ron Concialdi | Dentist | 2037 Jerry Murphy Rd., Pueblo, CO 81001 | 2013-11-14 |
| 1609146950 | Natasha Liette Mondragon | Registered Nurse | 1302 E. 5th, Pueblo, CO 81001 | 2012-01-04 |
| 1023303575 | Malinda Lee Davis | Registered Nurse | 1302 E 5th, Pueblo, CO 81001 | 2011-06-13 |
| 1679876429 | Michael Edward Leyba | Substance Abuse Rehabilitation Facility | 4 Montebello Rd., Pueblo, CO 81001 | 2010-12-17 |
| 1609008796 | Laura Ann Mcmahon | Nurse Practitioner | 4020 Jerry Murphy Rd/, Pueblo, CO 81001 | 2009-08-21 |
| 1730380882 | Corrine Stella Tafoya | Counselor | 44 Calhoun Rd, Pueblo, CO 81001 | 2007-05-29 |
| 1518171008 | George Henry Beck | Dentist | 1700 N Salem Ave, Suite A, Pueblo, CO 81001 | 2007-05-10 |
| Find all providers in zip 81001 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396307849 | Elizabeth Lee Cochran | Dentist | 4130 Redwood Ln Unit 130, Pueblo, CO 81005-3292 | 2019-07-05 |
| 1154879344 | Pdsc PC | Dentist | 2041 Pepper Ln, Pueblo, CO 81005-3276 | 2016-09-15 |
| 1437578028 | Pueblo Modern Dentistry and Orthodontics, LLP | Dentist | 727 Us Hwy 50 West, Pueblo, CO 81008 | 2014-04-10 |
| 1558655928 | Sarah Elizabeth Keen | Dentist | 4104 Outlook Blvd, Pueblo, CO 81008-1670 | 2011-06-03 |
| 1861790792 | Andrew Comerci | Dentist | 1100 Eagleridge Blvd, Pueblo, CO 81008-2103 | 2011-03-01 |
| 1467756627 | Anthony G Oreskovich | Dentist | 1111 Pueblo Boulevard Way, Suite 140, Pueblo, CO 81005-1687 | 2011-01-03 |
| 1033356670 | Park West Dental PC | Dentist | 3470 Parker Blvd, Pueblo, CO 81003 | 2009-01-20 |
| 1942479761 | James Cover D.d.s., PC | Dentist | 2020 S Pueblo Blvd, Pueblo, CO 81005-2546 | 2008-02-26 |
| 1801064928 | Garbiso Dental Care Center | Dentist | 3210 Wedgewood Dr, Pueblo, CO 81005-2398 | 2008-02-11 |
| 1790963957 | Douglas L. Pearson | Dentist | 2225 Norman Ln, Pueblo, CO 81005-3357 | 2008-02-09 |
| Find all providers in PUEBLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.