Healthcare Provider Details

I. General information

NPI: 1386043909
Provider Name (Legal Business Name): ALFREDO A DELA ROSA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6063 MISSION ST
DALY CITY CA
94014-2007
US

IV. Provider business mailing address

6063 MISSION ST
DALY CITY CA
94014-2007
US

V. Phone/Fax

Practice location:
  • Phone: 415-963-4121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number56785
License Number StateCA

VIII. Authorized Official

Name: ALFREDO A. DELA ROSA JR.
Title or Position: ORAL AND MAXILLOFACIAL SURGEON
Credential:
Phone: 415-963-4121