Nicolet Derose, D.D.S

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2362 Issued in WI

Practice address

316 5TH St
Racine, WI 53403-4606

Phone

(262) 534-8662

NPI assigned

Nov 29, 2006

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194892166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 5TH ST",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534034606",
            "telephone_number": "262-534-8662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 5TH ST",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534034606",
            "telephone_number": "262-534-8662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROSE",
        "first_name": "NICOLET",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "2362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Autumn R Depaoli, LPC-IT
• Monserratt Itzayana Derby, LPC
• Tia Derflinger, PA-C
• Derose Family Counseling, LLC.
• Francesca Derose
• Talia Catherine Derose, MSW
• Becky Derosia
• Matthew Deschler, PHARM. D.
• Nichole Deschler, PTA
• Britt Mae Devusic, PT

• Pediatric Dentistry in Racine, WI
• Providers in Racine, WI by specialty
• Pediatric Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.