Provider Demographics
NPI:1073510376
Name:ROSS, DENNIS L (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1035 N EMPORIA ST
Mailing Address - Street 2:STE #105
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2944
Mailing Address - Country:US
Mailing Address - Phone:316-263-7285
Mailing Address - Fax:316-266-4682
Practice Address - Street 1:1035 N EMPORIA ST
Practice Address - Street 2:STE #105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2944
Practice Address - Country:US
Practice Address - Phone:316-263-7285
Practice Address - Fax:316-266-4682
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0417656174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100120140AMedicaid
KS100120140AMedicaid
KSB68153Medicare UPIN