Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1033185871 Individual Practitioner Male Practitioner

Michael Anthony Derose

Dentist - General Practice • Pueblo, CO

Professional Overview & Biography Verified Profile Summary

Michael Derose is a registered healthcare professional specializing in Dentist - General Practice in Pueblo, CO. Practice services are available at 1022 LIBERTY LN under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1022 Liberty Ln

Pueblo, CO 810012039

Telephone 7195455778
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Pueblo, CO

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.5 Yrs
Regional Practice Density
67 Specialists

Practicing in Pueblo, CO (2613 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License CO DEN-5133

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Dentist - General Practice

NUCC Taxonomy Code: 1223G0001X

State License IN 12010424A

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Dentist - General Practice

NUCC Taxonomy Code: 1223G0001X

State License OK 5643

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Dentist - General Practice

NUCC Taxonomy Code: 1223G0001X

State License NM DD2030

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Dentist - General Practice

NUCC Taxonomy Code: 1223G0001X

State License KS 60184

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
2051332 (CO)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
Dr. Edward Derose , DDS

Dentist - General Practice

NPI 1275506222

Doctor of Dental Surgery

Dr. Adolph Padula , DDS

Dentist - General Practice

NPI 1881671436

Doctor of Dental Surgery

NPI 1922304237

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 13, 2026

Dentist (License #DEN-5133 in CO)

NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 09, 2007

Registered at 1022 LIBERTY LN, PUEBLO, CO 810012039 (Tel: 7195455778)

📍
Updated Business Mailing Address July 09, 2007

Registered at 415 N GRAND AVE, PUEBLO, CO 810033111 (Tel: 7195463333)

👤
Provider Name / Credentials Updated July 09, 2007

Recorded as MICHAEL DEROSE

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Dentist (License #DEN-5133 in CO)

🟢
Initial NPI Registration & Enumeration February 23, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1033185871
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 23, 2006
Last Update: July 13, 2026
Sole Proprietor: No

Mailing Address

415 N Grand Ave

Pueblo, CO 810033111

Phone: 7195463333

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.