Provider Demographics
NPI:1093718744
Name:HILDEBRAND, ROSS ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ALAN
Last Name:HILDEBRAND
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 1:3822 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-9733
Mailing Address - Country:US
Mailing Address - Phone:620-792-1231
Mailing Address - Fax:620-792-5146
Practice Address - Street 1:3822 6TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-9733
Practice Address - Country:US
Practice Address - Phone:620-792-1231
Practice Address - Fax:620-792-5146
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist