Provider Demographics
NPI:1588739353
Name:DELROSARIO, MICHAEL L (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:DELROSARIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OSBORNE ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905
Mailing Address - Country:US
Mailing Address - Phone:814-536-4675
Mailing Address - Fax:814-536-8897
Practice Address - Street 1:20 OSBORNE ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905
Practice Address - Country:US
Practice Address - Phone:814-536-4675
Practice Address - Fax:814-536-8897
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028079L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVA112926OtherHIGHMARK BCBS
PA102928OtherUPMC
PADE724957OtherUNITED CONCORDIA DENTAL
PAVA112926OtherHIGHMARK BCBS
PA724957FJSMedicare ID - Type Unspecified