Active NPI
Michael D Derosa, DDS
- General Practice Dentistry
- Saint Clairsville, OH
National Provider Identifier
1235290990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- OH17645
- Practice address
- 156 Woodrow Ave Ste 2
Saint Clairsville, OH 43950-1181 - Phone
- (740) 695-5400
- Fax
- (740) 695-4998
- NPI assigned
- Dec 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | OH17645 | OH | Primary |
Addresses
Primary practice location
156 Woodrow Ave Ste 2
Saint Clairsville, OH 43950-1181
Mailing address
156 Woodrow Ave Ste 2
Saint Clairsville, OH 43950-1181
Phone (740) 695-5400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 22, 2015 through Dec 22, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OH17645 | OH | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235290990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "156 WOODROW AVE STE 2",
"city": "SAINT CLAIRSVILLE",
"state": "OH",
"postal_code": "439501181",
"telephone_number": "740-695-5400",
"fax_number": "740-695-4998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "156 WOODROW AVE STE 2",
"city": "SAINT CLAIRSVILLE",
"state": "OH",
"postal_code": "439501181",
"telephone_number": "740-695-5400",
"fax_number": "740-695-4998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROSA",
"first_name": "MICHAEL",
"middle_name": "D",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "OH17645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Clairsville, OH
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.