Provider Demographics
NPI:1003989740
Name:ROSS, DONALD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 WINTERGREEN TER
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6367
Mailing Address - Country:US
Mailing Address - Phone:847-426-8799
Mailing Address - Fax:847-426-9415
Practice Address - Street 1:5000 SPRING HILL MALL
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1267
Practice Address - Country:US
Practice Address - Phone:800-426-8799
Practice Address - Fax:847-426-9415
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice