Peter D. Derose, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

040250 Issued in NY

Practice address

3030 Orchard Park Rd
West Seneca, NY 14224-4667

Phone

(716) 362-4800

Fax

(716) 348-3424

NPI assigned

Jun 1, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1407058407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 FRANKLIN ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142021110",
            "telephone_number": "716-883-0005",
            "fax_number": "716-883-0176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 ORCHARD PARK RD",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142244667",
            "telephone_number": "716-362-4800",
            "fax_number": "716-348-3424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROSE",
        "first_name": "PETER",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-01",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "040250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Demarzio, OTR
• Jennie Lynn Dembski, MD
• Thomas D Denecke, DC
• Christopher Lee Depasquale, BACHELOR OF NS DOCTO
• Anthony John Deplato, M.D.
• Lauren Marie Destro, DPT
• Tina Destro
• Colleen M Dhafir, N.P.
• Mazin A Dhafir, M.D.
• Pardeep Paul Dhanoa, DO

• General Practice Dentistry in West Seneca, NY
• Providers in West Seneca, 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 Nov 1, 2023; 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.