Provider Demographics
NPI:1447264924
Name:DELLA ROSA, MICHAEL RAYMOND (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:DELLA ROSA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ROUTE 70
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4022
Mailing Address - Country:US
Mailing Address - Phone:732-477-5770
Mailing Address - Fax:732-477-3433
Practice Address - Street 1:525 ROUTE 70
Practice Address - Street 2:SUITE 1A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4022
Practice Address - Country:US
Practice Address - Phone:732-477-5770
Practice Address - Fax:732-477-3433
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009434001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice