Provider Demographics
NPI:1154673838
Name:ROSS, DAVID J
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 12TH AVE SW
Mailing Address - Street 2:STE D
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 12TH AVE SW
Practice Address - Street 2:STE D
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8723
Practice Address - Country:US
Practice Address - Phone:701-232-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist