MICHAEL A DEROSE DDS PA NPI 1164467411

NPI Information

NPI: 1164467411
Provider Name: MICHAEL A DEROSE DDS PA
Classification: Dentist - 1223G0001X
Specialization: General Practice
Entity Type: Organization
Address: 2041 SILAS CREEK PKWY
WINSTON SALEM, NC
ZIP 27103
Phone: (336) 777-0303

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NPI Details

MICHAEL A DEROSE DDS PA is a general practice dentist in Winston Salem, NC. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. MICHAEL A DEROSE DDS PA NPI is 1164467411. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2041 SILAS CREEK PKWY
WINSTON SALEM, NC
ZIP 27103-147
Phone: (336) 777-0303
Fax: (336) 777-3448

The provider's authorized official is Michael Anthony Derose .
The authorized official title is Owner and has the following contact phone number (336) 777-0303.

The enumeration date for this NPI number is 6/19/2006 and was last updated on 7/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	89012P6	MEDICAID	NORTH CAROLINA
2	012P6	OTHER		BLUE CROSS BLUE SHIELD NC

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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