Provider Demographics
NPI:1043239130
Name:DREGER, ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:DREGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 COUNTY ROAD XX
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-7933
Mailing Address - Country:US
Mailing Address - Phone:715-359-0550
Mailing Address - Fax:
Practice Address - Street 1:1851 COUNTY ROAD XX
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-7933
Practice Address - Country:US
Practice Address - Phone:715-359-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00043780151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice