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General NPI Number Information
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NPI Number | 1861557415
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Entity Type | Organization
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Legal Business Name | REBECCA J DE LA ROSA, D.D.S., P.C.
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7318 E. U.S. 36 SUITE 100
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City | AVON
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State | IN
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Zip | 46123
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Country | US
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Telephone | 317-272-7715
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Fax | 317-272-7719
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Provider Business Mailing Address
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Address Line | 7318 E. U.S. 36 SUITE 100
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City | AVON
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State | IN
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Zip | 46123
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Country | US
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Telephone | 317-272-7715
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Fax | 317-272-7719
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Authorized Official
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Title or Position | PRESIDENT
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Name | REBECCA J DE LA ROSA
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Credential | D.D.S.
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Telephone | 317-272-7715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1200--9226
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License Number State | IN
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