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General NPI Number Information
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NPI Number | 1326534090
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Entity Type | Individual
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Provider Name | VANESSA DE LA ROSA DMD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 8905 TWO NOTCH RD
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City | COLUMBIA
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State | SC
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Zip | 29223-6367
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Country | US
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Telephone | 803-830-4387
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Fax |
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Provider Business Mailing Address
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Address Line | 8905 TWO NOTCH RD
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City | COLUMBIA
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State | SC
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Zip | 29223-6367
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Country | US
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Telephone | 803-830-4387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 102718
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 11285
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DGD.10161
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License Number State | SC
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