Thomas A Derosa, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

037122 Issued in NY

Practice address

625 Elmwood Ave
Eastman Dental Center
Rochester, NY 14620-2913

Phone

(585) 275-1117

NPI assigned

Mar 24, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458000000000",
    "number": "1114199783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ELMWOOD AVENUE",
            "address_2": "EASTMAN DENTAL CENTER",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146202913",
            "telephone_number": "585-275-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 ELMWOOD AVE",
            "address_2": "EASTMAN DENTAL CENTER",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146202913",
            "telephone_number": "585-275-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROSA",
        "first_name": "THOMAS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-24",
        "last_updated": "2016-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "037122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Agop Dermesropian, DMD
• Jennifer Deroller, M.S., ATR-BC, LCAT
• Alana Derooy
• Maria A Derosa, RPAC
• Tara A Derosa
• Angel Derose, CASAC
• Patrick A Derose, D.D.S.
• Shannon Derose, RPA-C
• Martha Ellen Derosia, FNP
• Susan M Derrick, RN

• General Practice Dentistry in Rochester, NY
• Providers in Rochester, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.