Provider Demographics
NPI:1093856213
Name:ROSS, GARY MCCABE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MCCABE
Last Name:ROSS
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 1:6830 MONTGOMERY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1455
Mailing Address - Country:US
Mailing Address - Phone:505-888-2606
Mailing Address - Fax:505-837-1635
Practice Address - Street 1:6830 MONTGOMERY BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1455
Practice Address - Country:US
Practice Address - Phone:505-888-2606
Practice Address - Fax:505-837-1635
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD13871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice