Gregory Derose JR., DDS

NPI #1225601511 in Fort Polk, Louisiana

Provider Information

NPI Number: 1225601511
Entity Type: Individual
Name: Gregory Derose JR., DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Jul 23, 2021
Last Updated: Jul 23, 2021

Practice Location

Address: 7223 MISSISSIPPI AVENUE
Address 2: BLDG 1561
City: Fort Polk
State: Louisiana
ZIP Code: 71459
Phone: (337) 531-2603

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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