Provider Demographics
NPI:1861557415
Name:REBECCA J DE LA ROSA, D.D.S., P.C.
Entity type:Organization
Organization Name:REBECCA J DE LA ROSA, D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-272-7715
Mailing Address - Street 1:7318 E. U.S. 36
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123
Mailing Address - Country:US
Mailing Address - Phone:317-272-7715
Mailing Address - Fax:317-272-7719
Practice Address - Street 1:7318 E. U.S. 36
Practice Address - Street 2:SUITE 100
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123
Practice Address - Country:US
Practice Address - Phone:317-272-7715
Practice Address - Fax:317-272-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1200--92261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty