Provider Demographics
NPI:1184043226
Name:ROSS, GABRIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 2ND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7887
Mailing Address - Country:US
Mailing Address - Phone:843-900-4490
Mailing Address - Fax:843-501-9450
Practice Address - Street 1:2001 2ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7887
Practice Address - Country:US
Practice Address - Phone:843-876-8815
Practice Address - Fax:843-876-8783
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
SC85741223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist