Provider Demographics
NPI:1285462887
Name:ROSE, MICHAELA (RDH)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 N PRESTWICK CT
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2333
Mailing Address - Country:US
Mailing Address - Phone:302-264-1628
Mailing Address - Fax:
Practice Address - Street 1:446 S NEW ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6725
Practice Address - Country:US
Practice Address - Phone:302-674-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG2-0013212124Q00000X
MD8948124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist