Provider Demographics
NPI:1154545846
Name:LAROSA, ROBERT FC
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FC
Last Name:LAROSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:357 MAIN ST SOUTH
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-0593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:357 MAIN ST S
Practice Address - Street 2:POB 593
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3408
Practice Address - Country:US
Practice Address - Phone:203-263-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice